| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,354 |
748 |
$909K |
| D1110 |
Prophylaxis - adult |
5,176 |
4,942 |
$274K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,263 |
1,360 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
5,941 |
5,684 |
$143K |
| D1120 |
Prophylaxis - child |
2,930 |
2,801 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,279 |
4,068 |
$118K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
233 |
130 |
$116K |
| D0274 |
Bitewings - four radiographic images |
3,075 |
2,959 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
1,535 |
1,449 |
$107K |
| D1351 |
Sealant - per tooth |
2,110 |
757 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
4,137 |
3,522 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,250 |
1,161 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
524 |
280 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
872 |
831 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
420 |
299 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
360 |
200 |
$24K |
| D2950 |
|
105 |
79 |
$17K |
| D2332 |
|
162 |
90 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
821 |
570 |
$9K |
| D0330 |
Panoramic radiographic image |
187 |
167 |
$8K |
| D2160 |
|
74 |
51 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
13 |
$4K |
| D2331 |
|
52 |
38 |
$4K |
| D2954 |
|
16 |
12 |
$3K |
| D2335 |
|
17 |
13 |
$2K |
| D1203 |
|
17 |
17 |
$0.00 |
| D1999 |
|
112 |
101 |
$0.00 |