| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
44 |
35 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
252 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
117 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
113 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
295 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
52 |
$15K |
| D2950 |
|
86 |
70 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
32 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$9K |
| D3320 |
|
14 |
14 |
$8K |
| D1110 |
Prophylaxis - adult |
107 |
107 |
$7K |
| D1351 |
Sealant - per tooth |
139 |
31 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
35 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
93 |
$4K |
| D2335 |
|
16 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
112 |
$1K |
| D1206 |
Topical application of fluoride varnish |
19 |
19 |
$560.12 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$535.08 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$442.20 |