| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
435 |
361 |
$268K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
473 |
260 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
836 |
803 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
518 |
164 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,053 |
1,017 |
$36K |
| D2950 |
|
262 |
225 |
$30K |
| D1110 |
Prophylaxis - adult |
566 |
555 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
518 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
71 |
$8K |
| D1206 |
Topical application of fluoride varnish |
377 |
280 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
266 |
254 |
$4K |
| D0330 |
Panoramic radiographic image |
64 |
62 |
$3K |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$2K |
| D0270 |
|
73 |
72 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
27 |
27 |
$743.90 |
| D1330 |
|
31 |
31 |
$0.00 |