| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
237 |
139 |
$194K |
| D1110 |
Prophylaxis - adult |
993 |
971 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,009 |
982 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
365 |
203 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
217 |
$30K |
| D0367 |
|
204 |
202 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
872 |
856 |
$20K |
| D2394 |
|
155 |
97 |
$16K |
| D9944 |
|
49 |
49 |
$13K |
| D0274 |
Bitewings - four radiographic images |
360 |
351 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
371 |
$12K |
| D1120 |
Prophylaxis - child |
416 |
409 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
182 |
$10K |
| D2950 |
|
77 |
55 |
$10K |
| D1206 |
Topical application of fluoride varnish |
401 |
396 |
$8K |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
266 |
237 |
$2K |
| D0470 |
|
63 |
63 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
12 |
$235.92 |