| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
867 |
216 |
$673K |
| D2750 |
|
1,020 |
367 |
$493K |
| D2950 |
|
2,159 |
775 |
$278K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,558 |
716 |
$206K |
| D4342 |
|
1,890 |
801 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,735 |
3,714 |
$149K |
| D0210 |
Intraoral - complete series of radiographic images |
1,450 |
1,439 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
647 |
312 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
240 |
159 |
$39K |
| D1110 |
Prophylaxis - adult |
511 |
508 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
783 |
779 |
$19K |
| D0274 |
Bitewings - four radiographic images |
474 |
472 |
$14K |
| D2394 |
|
54 |
36 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
855 |
845 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
261 |
258 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
284 |
282 |
$9K |
| D4341 |
|
33 |
13 |
$9K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$772.80 |