| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
365 |
283 |
$254K |
| D1110 |
Prophylaxis - adult |
1,903 |
1,834 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,096 |
1,051 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,450 |
1,395 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
736 |
464 |
$60K |
| D2954 |
|
219 |
170 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
944 |
908 |
$37K |
| D0274 |
Bitewings - four radiographic images |
926 |
901 |
$33K |
| D3320 |
|
57 |
46 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,891 |
1,814 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
312 |
128 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
759 |
741 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,149 |
1,074 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
335 |
331 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
95 |
$8K |
| D1120 |
Prophylaxis - child |
144 |
142 |
$7K |
| D2950 |
|
16 |
15 |
$3K |
| D2330 |
|
25 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0270 |
|
21 |
21 |
$289.00 |