| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
133 |
93 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
513 |
184 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
732 |
714 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
109 |
$20K |
| D2950 |
|
145 |
121 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
810 |
785 |
$10K |
| D9219 |
|
155 |
154 |
$6K |
| D0350 |
|
129 |
129 |
$4K |
| D2335 |
|
22 |
12 |
$4K |
| D4910 |
|
25 |
25 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$3K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$649.56 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$184.94 |