| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
677 |
491 |
$478K |
| D1110 |
Prophylaxis - adult |
5,633 |
5,473 |
$295K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
250 |
173 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
1,531 |
1,490 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,079 |
3,915 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,135 |
718 |
$84K |
| D0274 |
Bitewings - four radiographic images |
1,571 |
1,555 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,377 |
1,344 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
958 |
$39K |
| D1206 |
Topical application of fluoride varnish |
756 |
692 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,110 |
1,073 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
109 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
53 |
$7K |
| D1120 |
Prophylaxis - child |
122 |
118 |
$6K |
| D2331 |
|
16 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
12 |
$277.00 |