| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
303 |
208 |
$136K |
| D1110 |
Prophylaxis - adult |
1,743 |
1,738 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
880 |
550 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
609 |
411 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,558 |
1,551 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
356 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
497 |
296 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
474 |
472 |
$20K |
| D2331 |
|
324 |
190 |
$19K |
| D2332 |
|
289 |
166 |
$17K |
| D0274 |
Bitewings - four radiographic images |
623 |
621 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,865 |
1,784 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,169 |
1,056 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
575 |
574 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
447 |
$9K |
| D0330 |
Panoramic radiographic image |
99 |
99 |
$3K |
| D2330 |
|
31 |
26 |
$2K |
| D2954 |
|
20 |
20 |
$2K |
| D1310 |
|
225 |
224 |
$1K |
| D1330 |
|
224 |
223 |
$1K |
| D9110 |
|
14 |
13 |
$396.90 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$221.13 |