| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
142 |
99 |
$92K |
| D1110 |
Prophylaxis - adult |
650 |
598 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
463 |
150 |
$33K |
| D0274 |
Bitewings - four radiographic images |
588 |
546 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
348 |
157 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
681 |
642 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
872 |
800 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
128 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
707 |
640 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
163 |
158 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
151 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
56 |
$6K |
| D1120 |
Prophylaxis - child |
96 |
92 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
90 |
85 |
$3K |
| D2330 |
|
59 |
16 |
$3K |
| D2950 |
|
13 |
12 |
$2K |