| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
118 |
100 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
601 |
585 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
760 |
$34K |
| D4342 |
|
390 |
150 |
$34K |
| D2950 |
|
163 |
135 |
$26K |
| D1110 |
Prophylaxis - adult |
396 |
380 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
25 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
141 |
51 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
118 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
171 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
374 |
360 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
38 |
$4K |
| D0274 |
Bitewings - four radiographic images |
83 |
79 |
$3K |
| D1120 |
Prophylaxis - child |
66 |
64 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
88 |
85 |
$3K |
| D1351 |
Sealant - per tooth |
63 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
110 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
15 |
14 |
$340.20 |