| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
382 |
164 |
$256K |
| D7140 |
Extraction, erupted tooth or exposed root |
434 |
73 |
$43K |
| D1110 |
Prophylaxis - adult |
272 |
271 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
271 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
397 |
393 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
42 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
478 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
29 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
160 |
$4K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
77 |
$3K |
| D2950 |
|
19 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
87 |
86 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |