| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
219 |
219 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
163 |
152 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
24 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
24 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
89 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
94 |
92 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
90 |
$1K |