| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,032 |
637 |
$716K |
| D2954 |
|
900 |
520 |
$154K |
| D3320 |
|
297 |
205 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
1,373 |
1,218 |
$93K |
| D1110 |
Prophylaxis - adult |
1,455 |
1,345 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,710 |
1,488 |
$68K |
| D3310 |
|
122 |
75 |
$58K |
| D4342 |
|
730 |
215 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
548 |
344 |
$42K |
| D0274 |
Bitewings - four radiographic images |
769 |
753 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
627 |
594 |
$23K |
| D1120 |
Prophylaxis - child |
450 |
414 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
796 |
784 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
641 |
569 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,012 |
927 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
86 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
55 |
$6K |
| D1351 |
Sealant - per tooth |
130 |
29 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
322 |
261 |
$4K |
| D2950 |
|
15 |
12 |
$2K |
| D3120 |
|
43 |
27 |
$1K |
| D9110 |
|
12 |
12 |
$385.00 |