| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
146 |
87 |
$77K |
| D0380 |
|
157 |
157 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
65 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
367 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
211 |
$10K |
| D2950 |
|
62 |
37 |
$8K |
| D0383 |
|
59 |
59 |
$8K |
| D1110 |
Prophylaxis - adult |
154 |
153 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
474 |
459 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
84 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
41 |
$918.84 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$775.89 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
30 |
$483.05 |