| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
131 |
72 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
383 |
382 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
514 |
514 |
$21K |
| D1110 |
Prophylaxis - adult |
285 |
285 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
50 |
$12K |
| D2950 |
|
67 |
52 |
$11K |
| D4341 |
|
77 |
24 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
266 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
173 |
173 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
81 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
16 |
$3K |
| D0274 |
Bitewings - four radiographic images |
79 |
79 |
$2K |
| D1120 |
Prophylaxis - child |
36 |
36 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
107 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$1K |