| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
197 |
91 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
497 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,008 |
1,982 |
$82K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,307 |
$65K |
| D0330 |
Panoramic radiographic image |
894 |
887 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,299 |
1,277 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
129 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,092 |
1,072 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
250 |
102 |
$24K |
| D2950 |
|
154 |
72 |
$20K |
| D1120 |
Prophylaxis - child |
444 |
437 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
419 |
406 |
$15K |
| D1206 |
Topical application of fluoride varnish |
769 |
755 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
67 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
140 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
773 |
746 |
$10K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$830.14 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
15 |
$291.36 |