| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
462 |
198 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
843 |
379 |
$94K |
| D2950 |
|
368 |
194 |
$59K |
| D1110 |
Prophylaxis - adult |
846 |
843 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
972 |
957 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
874 |
871 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,517 |
1,344 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
203 |
87 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
460 |
373 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
475 |
$18K |
| D0274 |
Bitewings - four radiographic images |
409 |
409 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,824 |
861 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
54 |
$10K |
| D1206 |
Topical application of fluoride varnish |
513 |
513 |
$9K |
| D4355 |
|
65 |
65 |
$6K |
| D0330 |
Panoramic radiographic image |
69 |
69 |
$4K |
| D1120 |
Prophylaxis - child |
98 |
98 |
$4K |
| D2954 |
|
18 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
43 |
$1K |