| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
815 |
503 |
$516K |
| D1110 |
Prophylaxis - adult |
3,046 |
2,838 |
$152K |
| D2950 |
|
764 |
479 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,308 |
2,157 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,799 |
2,646 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,869 |
3,556 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,485 |
1,386 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,977 |
2,357 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
174 |
75 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
442 |
418 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
104 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
12 |
$11K |
| D1206 |
Topical application of fluoride varnish |
256 |
248 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
54 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
32 |
$4K |
| D1120 |
Prophylaxis - child |
65 |
61 |
$3K |
| D0330 |
Panoramic radiographic image |
43 |
38 |
$2K |