| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,182 |
503 |
$171K |
| D2740 |
Crown - porcelain/ceramic |
167 |
105 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
524 |
268 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,174 |
2,160 |
$55K |
| D0330 |
Panoramic radiographic image |
1,170 |
1,169 |
$46K |
| D1110 |
Prophylaxis - adult |
1,112 |
1,112 |
$39K |
| D2950 |
|
178 |
150 |
$31K |
| D0274 |
Bitewings - four radiographic images |
883 |
883 |
$23K |
| D3320 |
|
45 |
44 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,085 |
1,085 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,137 |
1,135 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
492 |
492 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
87 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
42 |
$8K |
| D1120 |
Prophylaxis - child |
125 |
125 |
$5K |
| D1206 |
Topical application of fluoride varnish |
148 |
148 |
$4K |
| D4355 |
|
145 |
145 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
216 |
216 |
$3K |
| D0180 |
|
54 |
54 |
$2K |
| D4910 |
|
12 |
12 |
$1K |