| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
490 |
151 |
$322K |
| D1110 |
Prophylaxis - adult |
1,568 |
1,512 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,441 |
1,374 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,569 |
1,518 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
441 |
276 |
$33K |
| D4341 |
|
193 |
49 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
972 |
951 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
514 |
503 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
141 |
37 |
$16K |
| D0274 |
Bitewings - four radiographic images |
570 |
556 |
$15K |
| D2950 |
|
101 |
47 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,335 |
1,262 |
$13K |
| D1120 |
Prophylaxis - child |
99 |
98 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
587 |
482 |
$4K |
| D4910 |
|
46 |
45 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
131 |
128 |
$3K |
| D1351 |
Sealant - per tooth |
60 |
17 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |
| D4355 |
|
30 |
29 |
$1K |