| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
174 |
116 |
$114K |
| D4342 |
|
1,176 |
493 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,137 |
4,055 |
$97K |
| D1110 |
Prophylaxis - adult |
1,852 |
1,829 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,731 |
1,726 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
842 |
827 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,107 |
2,095 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,775 |
4,653 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,464 |
1,427 |
$38K |
| D2950 |
|
185 |
118 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
586 |
580 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
78 |
$19K |
| D4910 |
|
113 |
110 |
$9K |
| D4341 |
|
28 |
12 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
16 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
14 |
$3K |