| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
731 |
498 |
$347K |
| D1110 |
Prophylaxis - adult |
1,712 |
1,701 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,924 |
1,911 |
$126K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,008 |
4,524 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
1,053 |
$60K |
| D4341 |
|
739 |
204 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,456 |
2,434 |
$51K |
| D2954 |
|
388 |
304 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
340 |
198 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
708 |
358 |
$38K |
| D0330 |
Panoramic radiographic image |
758 |
750 |
$22K |
| D1120 |
Prophylaxis - child |
218 |
218 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
97 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
38 |
$5K |
| D9430 |
|
120 |
119 |
$4K |
| D2330 |
|
23 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
188 |
$2K |
| D9110 |
|
27 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |