| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
314 |
166 |
$178K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,801 |
469 |
$120K |
| D1110 |
Prophylaxis - adult |
655 |
647 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,058 |
1,015 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
196 |
$31K |
| D0274 |
Bitewings - four radiographic images |
590 |
586 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
153 |
$18K |
| D0330 |
Panoramic radiographic image |
316 |
291 |
$17K |
| D2950 |
|
154 |
105 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
169 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
474 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
534 |
534 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
43 |
$11K |
| D1206 |
Topical application of fluoride varnish |
548 |
542 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
959 |
912 |
$11K |
| D2330 |
|
129 |
82 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
55 |
$8K |
| D2331 |
|
85 |
59 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
549 |
389 |
$6K |
| D9420 |
|
33 |
33 |
$3K |
| D2140 |
|
27 |
15 |
$1K |
| D9995 |
|
75 |
75 |
$0.00 |