| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
160 |
96 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,002 |
460 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
542 |
308 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
178 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
140 |
52 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
330 |
$18K |
| D1110 |
Prophylaxis - adult |
408 |
394 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
432 |
425 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
397 |
345 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
365 |
356 |
$8K |
| D1206 |
Topical application of fluoride varnish |
320 |
311 |
$7K |
| D0330 |
Panoramic radiographic image |
140 |
138 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
212 |
206 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
424 |
$4K |
| D0274 |
Bitewings - four radiographic images |
171 |
167 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
252 |
157 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$992.20 |
| D1120 |
Prophylaxis - child |
27 |
27 |
$928.86 |