| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
685 |
426 |
$326K |
| D1110 |
Prophylaxis - adult |
1,932 |
1,920 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,691 |
1,679 |
$108K |
| D2954 |
|
613 |
399 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,355 |
1,350 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
913 |
908 |
$56K |
| D4341 |
|
682 |
189 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
278 |
147 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,865 |
1,392 |
$32K |
| D9430 |
|
894 |
863 |
$29K |
| D5750 |
|
69 |
69 |
$13K |
| D5751 |
|
66 |
66 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,039 |
1,017 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
97 |
$11K |
| D0272 |
Bitewings - two radiographic images |
296 |
295 |
$4K |
| D0330 |
Panoramic radiographic image |
105 |
105 |
$3K |
| D4342 |
|
32 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
68 |
68 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$630.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$168.00 |