| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
397 |
254 |
$254K |
| D0330 |
Panoramic radiographic image |
1,905 |
1,877 |
$100K |
| D1110 |
Prophylaxis - adult |
2,051 |
2,021 |
$98K |
| D2394 |
|
436 |
276 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
448 |
241 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,932 |
1,831 |
$69K |
| D0350 |
|
1,834 |
1,638 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,514 |
1,492 |
$61K |
| D0460 |
|
2,013 |
1,787 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,666 |
1,650 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
182 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,575 |
1,557 |
$39K |
| D2950 |
|
270 |
170 |
$36K |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
15 |
$9K |
| D1120 |
Prophylaxis - child |
200 |
192 |
$7K |
| D4910 |
|
80 |
79 |
$6K |
| D1206 |
Topical application of fluoride varnish |
283 |
274 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
417 |
399 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
26 |
$5K |
| D9310 |
|
26 |
26 |
$917.70 |