| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
471 |
242 |
$312K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
905 |
376 |
$124K |
| D1110 |
Prophylaxis - adult |
1,936 |
1,860 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
772 |
369 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,612 |
1,556 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,136 |
2,063 |
$50K |
| D2950 |
|
315 |
175 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
652 |
258 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
532 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
773 |
732 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
460 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
642 |
629 |
$19K |
| D1120 |
Prophylaxis - child |
328 |
318 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
871 |
823 |
$13K |
| D1351 |
Sealant - per tooth |
101 |
24 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
261 |
153 |
$3K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D3120 |
|
31 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
21 |
17 |
$512.00 |