| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,039 |
392 |
$744K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,850 |
2,100 |
$502K |
| D4342 |
|
2,428 |
985 |
$233K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,141 |
1,159 |
$220K |
| D1110 |
Prophylaxis - adult |
4,198 |
4,188 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
5,827 |
5,807 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
1,644 |
1,638 |
$131K |
| D2950 |
|
1,005 |
352 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,844 |
2,838 |
$116K |
| D0274 |
Bitewings - four radiographic images |
2,638 |
2,633 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
443 |
303 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
440 |
224 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,424 |
1,415 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,634 |
3,586 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,908 |
1,890 |
$32K |
| D4910 |
|
282 |
282 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$2K |