| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
404 |
310 |
$183K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
812 |
415 |
$50K |
| D2950 |
|
397 |
319 |
$46K |
| D2160 |
|
548 |
278 |
$41K |
| D2332 |
|
577 |
225 |
$33K |
| D1110 |
Prophylaxis - adult |
733 |
728 |
$31K |
| D4341 |
|
259 |
95 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
502 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
771 |
751 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
706 |
695 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
603 |
596 |
$12K |
| D0274 |
Bitewings - four radiographic images |
401 |
393 |
$10K |
| D1120 |
Prophylaxis - child |
227 |
221 |
$7K |
| D2140 |
|
143 |
99 |
$7K |
| D1351 |
Sealant - per tooth |
187 |
31 |
$5K |
| D1206 |
Topical application of fluoride varnish |
212 |
212 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
311 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
116 |
$3K |
| D4910 |
|
40 |
40 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
86 |
75 |
$2K |
| D2335 |
|
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
70 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
25 |
$1K |