| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
116 |
67 |
$98K |
| D0350 |
|
464 |
462 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
557 |
190 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
210 |
$57K |
| D0160 |
|
408 |
406 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
87 |
$25K |
| D2950 |
|
117 |
71 |
$16K |
| D9410 |
|
84 |
82 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
112 |
$6K |
| D2330 |
|
50 |
29 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
14 |
$5K |
| D2335 |
|
21 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
97 |
$1K |