| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,082 |
588 |
$701K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,180 |
2,344 |
$545K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,919 |
1,102 |
$279K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,209 |
772 |
$185K |
| D2950 |
|
982 |
598 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,110 |
3,059 |
$120K |
| D1110 |
Prophylaxis - adult |
2,731 |
2,692 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
968 |
589 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,067 |
1,039 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,986 |
2,952 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,968 |
1,926 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,084 |
2,058 |
$60K |
| D4342 |
|
495 |
193 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,538 |
3,461 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
559 |
542 |
$9K |
| D2791 |
|
14 |
13 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$6K |
| D2331 |
|
45 |
27 |
$5K |
| D2394 |
|
17 |
15 |
$3K |
| D4910 |
|
12 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
41 |
40 |
$666.70 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$471.45 |