| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
901 |
155 |
$161K |
| D2740 |
Crown - porcelain/ceramic |
135 |
93 |
$127K |
| D4342 |
|
998 |
289 |
$126K |
| D0367 |
|
359 |
347 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
678 |
652 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
87 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
64 |
$33K |
| D7311 |
|
168 |
103 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
174 |
$20K |
| D1110 |
Prophylaxis - adult |
147 |
135 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
145 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
386 |
369 |
$8K |
| D0274 |
Bitewings - four radiographic images |
138 |
134 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
163 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
158 |
$3K |
| D9110 |
|
12 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$1K |