| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
317 |
199 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,078 |
1,054 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,536 |
$105K |
| D4910 |
|
1,272 |
1,269 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,711 |
836 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
1,164 |
1,160 |
$87K |
| D4341 |
|
948 |
280 |
$66K |
| D1120 |
Prophylaxis - child |
1,269 |
1,261 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,165 |
2,158 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
836 |
836 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,443 |
1,896 |
$39K |
| D0350 |
|
3,304 |
1,367 |
$35K |
| D1110 |
Prophylaxis - adult |
323 |
323 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
341 |
239 |
$27K |
| D1310 |
|
418 |
418 |
$19K |
| D0274 |
Bitewings - four radiographic images |
641 |
639 |
$14K |
| D0603 |
|
296 |
296 |
$4K |
| D1351 |
Sealant - per tooth |
152 |
39 |
$4K |
| D1320 |
|
297 |
296 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
297 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
75 |
73 |
$3K |
| D9430 |
|
63 |
62 |
$2K |
| D4342 |
|
37 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$1K |