| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
350 |
211 |
$239K |
| D1110 |
Prophylaxis - adult |
2,053 |
1,999 |
$131K |
| D1120 |
Prophylaxis - child |
2,233 |
2,164 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,496 |
3,401 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,826 |
2,737 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
741 |
439 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,517 |
1,476 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
964 |
909 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,328 |
2,257 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,979 |
1,855 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
372 |
356 |
$26K |
| D0330 |
Panoramic radiographic image |
434 |
423 |
$23K |
| D1351 |
Sealant - per tooth |
582 |
118 |
$21K |
| D2950 |
|
133 |
94 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
443 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
113 |
$16K |
| D0272 |
Bitewings - two radiographic images |
402 |
388 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
12 |
$9K |
| D1206 |
Topical application of fluoride varnish |
70 |
70 |
$2K |