| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
520 |
306 |
$354K |
| D1110 |
Prophylaxis - adult |
2,427 |
2,365 |
$124K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
614 |
271 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,007 |
508 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,274 |
498 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,990 |
1,919 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
926 |
895 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,662 |
1,576 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,418 |
1,374 |
$58K |
| D4342 |
|
738 |
244 |
$55K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
91 |
52 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,015 |
1,969 |
$46K |
| D2950 |
|
233 |
130 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,869 |
1,778 |
$27K |
| D1120 |
Prophylaxis - child |
434 |
418 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
623 |
599 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
708 |
578 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
38 |
$5K |
| D0270 |
|
182 |
174 |
$2K |
| D1351 |
Sealant - per tooth |
52 |
13 |
$2K |
| D2332 |
|
13 |
12 |
$2K |
| D2330 |
|
19 |
12 |
$1K |