| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
735 |
437 |
$426K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,856 |
954 |
$248K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
920 |
493 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
2,719 |
2,685 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,385 |
1,372 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,901 |
1,893 |
$76K |
| D1110 |
Prophylaxis - adult |
1,618 |
1,613 |
$72K |
| D2950 |
|
484 |
319 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,330 |
2,320 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,317 |
4,244 |
$54K |
| D2394 |
|
249 |
152 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
933 |
$35K |
| D4342 |
|
229 |
109 |
$20K |
| D0274 |
Bitewings - four radiographic images |
494 |
493 |
$15K |
| D0460 |
|
173 |
173 |
$5K |
| D2335 |
|
22 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$3K |
| D0180 |
|
52 |
52 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$833.16 |
| D0270 |
|
45 |
45 |
$569.74 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$196.80 |