| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
705 |
542 |
$362K |
| D1110 |
Prophylaxis - adult |
2,653 |
2,613 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,062 |
464 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,788 |
1,771 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
651 |
349 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,025 |
993 |
$26K |
| D2954 |
|
355 |
288 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
680 |
657 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
202 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,752 |
1,732 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
24 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
515 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,355 |
2,283 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,901 |
1,865 |
$8K |
| D1120 |
Prophylaxis - child |
207 |
206 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
206 |
24 |
$5K |
| D0330 |
Panoramic radiographic image |
127 |
126 |
$4K |
| D1206 |
Topical application of fluoride varnish |
132 |
131 |
$2K |
| D0603 |
|
117 |
116 |
$850.00 |
| D0270 |
|
41 |
40 |
$147.00 |
| D0350 |
|
38 |
38 |
$102.00 |