| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
384 |
252 |
$255K |
| D1110 |
Prophylaxis - adult |
1,406 |
1,338 |
$76K |
| D2950 |
|
431 |
296 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
607 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
245 |
57 |
$30K |
| D0274 |
Bitewings - four radiographic images |
805 |
766 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
622 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
707 |
647 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
339 |
217 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,065 |
1,020 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
437 |
425 |
$13K |
| D1120 |
Prophylaxis - child |
254 |
243 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
123 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
701 |
622 |
$10K |
| D0330 |
Panoramic radiographic image |
130 |
118 |
$7K |
| D0272 |
Bitewings - two radiographic images |
108 |
105 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
140 |
85 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$2K |
| D2330 |
|
25 |
13 |
$1K |