| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
330 |
247 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,103 |
639 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,127 |
623 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
1,058 |
1,011 |
$67K |
| D2950 |
|
557 |
477 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,007 |
1,875 |
$64K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
80 |
68 |
$39K |
| D1110 |
Prophylaxis - adult |
813 |
775 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,232 |
1,153 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,632 |
1,555 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,151 |
1,982 |
$33K |
| D0274 |
Bitewings - four radiographic images |
952 |
896 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
195 |
108 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
48 |
$10K |
| D4341 |
|
52 |
25 |
$9K |
| D0270 |
|
147 |
134 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
144 |
105 |
$1K |