| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,908 |
514 |
$1.10M |
| D1110 |
Prophylaxis - adult |
3,918 |
3,554 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
4,058 |
3,743 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,119 |
1,033 |
$77K |
| D1120 |
Prophylaxis - child |
1,259 |
1,202 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,202 |
2,092 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,492 |
1,332 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,040 |
958 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
661 |
547 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
128 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,081 |
878 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
43 |
$6K |
| D2394 |
|
26 |
14 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
59 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
81 |
$2K |
| D0270 |
|
14 |
13 |
$199.00 |
| D0470 |
|
46 |
46 |
$0.00 |
| D4999 |
|
24 |
24 |
$0.00 |