| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
4,384 |
1,431 |
$434K |
| D2740 |
Crown - porcelain/ceramic |
430 |
159 |
$365K |
| D2750 |
|
544 |
365 |
$267K |
| D2950 |
|
1,529 |
863 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,168 |
556 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,735 |
3,681 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
3,812 |
3,772 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
959 |
952 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
326 |
134 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
489 |
228 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,398 |
1,387 |
$43K |
| D1110 |
Prophylaxis - adult |
820 |
805 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
224 |
117 |
$36K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
45 |
31 |
$19K |
| D4910 |
|
235 |
235 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
499 |
494 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,261 |
1,247 |
$16K |
| D1206 |
Topical application of fluoride varnish |
142 |
140 |
$3K |