| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
202 |
138 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,215 |
793 |
$130K |
| D1110 |
Prophylaxis - adult |
2,930 |
2,907 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,953 |
3,912 |
$94K |
| D0274 |
Bitewings - four radiographic images |
1,878 |
1,862 |
$54K |
| D1120 |
Prophylaxis - child |
1,249 |
1,234 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
587 |
370 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,063 |
2,977 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,764 |
2,367 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
953 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,278 |
1,260 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
194 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
28 |
$4K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$3K |