| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
711 |
445 |
$337K |
| D9430 |
|
2,535 |
1,806 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
911 |
909 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
789 |
786 |
$38K |
| D4341 |
|
446 |
159 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,145 |
829 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
105 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
140 |
140 |
$10K |
| D1110 |
Prophylaxis - adult |
78 |
78 |
$7K |
| D4910 |
|
80 |
80 |
$6K |
| D1320 |
|
297 |
297 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
38 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
25 |
$4K |
| D0274 |
Bitewings - four radiographic images |
125 |
125 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
196 |
187 |
$2K |
| D0270 |
|
122 |
116 |
$610.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$594.00 |
| D0460 |
|
76 |
76 |
$0.00 |
| D0431 |
|
12 |
12 |
$0.00 |
| D0603 |
|
16 |
16 |
$0.00 |
| D1310 |
|
17 |
17 |
$0.00 |