| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
434 |
319 |
$293K |
| D1110 |
Prophylaxis - adult |
4,728 |
4,382 |
$241K |
| D0330 |
Panoramic radiographic image |
2,375 |
2,153 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,885 |
4,577 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,799 |
2,535 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,243 |
818 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,009 |
2,744 |
$88K |
| D1120 |
Prophylaxis - child |
1,085 |
1,024 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,698 |
3,288 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
987 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,579 |
1,489 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
406 |
262 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,563 |
1,281 |
$20K |
| D1351 |
Sealant - per tooth |
456 |
102 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
85 |
$9K |
| D0270 |
|
659 |
594 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
214 |
201 |
$5K |
| D2950 |
|
31 |
30 |
$5K |
| D0272 |
Bitewings - two radiographic images |
225 |
211 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
46 |
$3K |
| D9941 |
|
13 |
12 |
$1K |
| D0180 |
|
26 |
25 |
$888.00 |
| D9986 |
|
120 |
106 |
$0.00 |