| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
487 |
390 |
$268K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,373 |
1,252 |
$168K |
| D1110 |
Prophylaxis - adult |
3,611 |
3,611 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
4,845 |
4,845 |
$122K |
| D1206 |
Topical application of fluoride varnish |
3,765 |
3,765 |
$119K |
| D1120 |
Prophylaxis - child |
2,322 |
2,322 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,033 |
636 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,172 |
1,163 |
$53K |
| D2954 |
|
458 |
379 |
$44K |
| D0274 |
Bitewings - four radiographic images |
3,345 |
3,345 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
686 |
686 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,770 |
3,759 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
233 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,691 |
4,638 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
809 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,393 |
1,386 |
$14K |
| D0603 |
|
1,318 |
1,318 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
63 |
$6K |
| D9920 |
|
244 |
240 |
$6K |
| D0240 |
|
193 |
193 |
$4K |
| D0602 |
|
329 |
329 |
$3K |
| D0270 |
|
578 |
574 |
$3K |
| D2331 |
|
32 |
24 |
$2K |