| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
316 |
188 |
$216K |
| D4342 |
|
873 |
302 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,054 |
1,032 |
$47K |
| D1110 |
Prophylaxis - adult |
834 |
811 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
375 |
106 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
265 |
$35K |
| D0274 |
Bitewings - four radiographic images |
726 |
706 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
266 |
151 |
$22K |
| D5212 |
|
37 |
36 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
446 |
417 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
739 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
384 |
379 |
$9K |
| D5211 |
|
12 |
12 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
64 |
$5K |
| D2950 |
|
16 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
83 |
80 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
95 |
$1K |