| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
777 |
502 |
$543K |
| D1110 |
Prophylaxis - adult |
3,249 |
3,145 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,082 |
703 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,598 |
1,559 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,052 |
583 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,354 |
2,275 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,476 |
1,435 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,030 |
979 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
523 |
499 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,210 |
2,114 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,137 |
1,106 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
256 |
$34K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
29 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,934 |
1,480 |
$25K |
| D2950 |
|
140 |
102 |
$21K |
| D1120 |
Prophylaxis - child |
334 |
332 |
$18K |
| D1351 |
Sealant - per tooth |
198 |
49 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
24 |
$4K |
| D4341 |
|
30 |
16 |
$4K |
| D4342 |
|
32 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
17 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$368.00 |