| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
325 |
227 |
$155K |
| D1110 |
Prophylaxis - adult |
1,731 |
1,722 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
2,474 |
2,464 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,882 |
1,877 |
$118K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,190 |
3,399 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,139 |
693 |
$76K |
| D1120 |
Prophylaxis - child |
1,974 |
1,967 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,291 |
3,251 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,444 |
2,432 |
$30K |
| D2954 |
|
222 |
156 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
222 |
74 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
43 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
43 |
$4K |
| D0272 |
Bitewings - two radiographic images |
287 |
285 |
$3K |
| D1351 |
Sealant - per tooth |
138 |
29 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
37 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
182 |
$2K |
| D9430 |
|
37 |
37 |
$1K |