| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
555 |
446 |
$264K |
| D1110 |
Prophylaxis - adult |
2,250 |
2,240 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
1,755 |
1,743 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,842 |
1,832 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,104 |
607 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,150 |
820 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,498 |
1,489 |
$72K |
| D4910 |
|
888 |
886 |
$68K |
| D1206 |
Topical application of fluoride varnish |
3,176 |
3,159 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,267 |
2,300 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,754 |
1,744 |
$36K |
| D1120 |
Prophylaxis - child |
743 |
736 |
$36K |
| D9430 |
|
715 |
577 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
253 |
$20K |
| D2330 |
|
202 |
129 |
$16K |
| D2954 |
|
144 |
128 |
$15K |
| D1320 |
|
659 |
658 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
296 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
15 |
$2K |
| D4342 |
|
46 |
12 |
$2K |
| D0350 |
|
120 |
46 |
$1K |
| D2920 |
|
23 |
15 |
$966.00 |
| D9951 |
|
12 |
12 |
$385.00 |
| D0270 |
|
56 |
52 |
$280.00 |