| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
971 |
461 |
$655K |
| D1110 |
Prophylaxis - adult |
4,338 |
3,779 |
$198K |
| D2950 |
|
943 |
509 |
$145K |
| D0274 |
Bitewings - four radiographic images |
2,881 |
2,475 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,923 |
3,422 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,366 |
550 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,988 |
4,149 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,563 |
1,300 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
706 |
646 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
328 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,744 |
3,027 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
314 |
151 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
911 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
766 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
311 |
158 |
$22K |
| D1120 |
Prophylaxis - child |
371 |
304 |
$15K |
| D4341 |
|
121 |
25 |
$11K |
| D2330 |
|
103 |
42 |
$7K |
| D2954 |
|
28 |
26 |
$5K |
| D2332 |
|
18 |
12 |
$2K |
| D2394 |
|
22 |
12 |
$2K |