| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
477 |
223 |
$334K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,444 |
866 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,316 |
785 |
$178K |
| D2950 |
|
586 |
304 |
$78K |
| D1110 |
Prophylaxis - adult |
1,510 |
1,458 |
$70K |
| D2394 |
|
290 |
195 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
779 |
772 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,352 |
1,324 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
471 |
178 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
893 |
875 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,157 |
2,108 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,043 |
1,030 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
588 |
581 |
$16K |
| D2332 |
|
92 |
52 |
$14K |
| D0274 |
Bitewings - four radiographic images |
353 |
347 |
$11K |
| D0460 |
|
192 |
181 |
$5K |
| D2331 |
|
17 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D0270 |
|
70 |
70 |
$916.03 |