| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
648 |
476 |
$420K |
| D1110 |
Prophylaxis - adult |
6,191 |
6,070 |
$338K |
| D0274 |
Bitewings - four radiographic images |
6,793 |
6,680 |
$259K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,252 |
1,568 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
7,770 |
7,632 |
$191K |
| D1120 |
Prophylaxis - child |
2,822 |
2,793 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
7,103 |
6,867 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,844 |
1,269 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,361 |
1,329 |
$96K |
| D1206 |
Topical application of fluoride varnish |
3,279 |
3,251 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,640 |
5,457 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
628 |
491 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,206 |
1,157 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,577 |
1,542 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
847 |
818 |
$37K |
| D2950 |
|
230 |
174 |
$34K |
| D4342 |
|
360 |
126 |
$30K |
| D1351 |
Sealant - per tooth |
291 |
99 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
39 |
$4K |
| D2394 |
|
15 |
13 |
$2K |