| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
609 |
428 |
$390K |
| D1110 |
Prophylaxis - adult |
3,878 |
3,633 |
$201K |
| D1120 |
Prophylaxis - child |
3,194 |
3,067 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,373 |
827 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,675 |
4,384 |
$111K |
| D1206 |
Topical application of fluoride varnish |
4,549 |
4,356 |
$111K |
| D2950 |
|
586 |
438 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,323 |
1,245 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,510 |
1,410 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
620 |
547 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
580 |
371 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
733 |
686 |
$27K |
| D0330 |
Panoramic radiographic image |
263 |
259 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
26 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
110 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
103 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
721 |
$11K |
| D1351 |
Sealant - per tooth |
285 |
68 |
$10K |
| D0272 |
Bitewings - two radiographic images |
294 |
287 |
$8K |
| D0270 |
|
16 |
16 |
$227.00 |