| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
293 |
189 |
$181K |
| D2950 |
|
333 |
227 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
959 |
956 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
244 |
$52K |
| D1110 |
Prophylaxis - adult |
902 |
895 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,209 |
1,203 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
228 |
123 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
481 |
452 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
29 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
380 |
375 |
$10K |
| D3320 |
|
18 |
12 |
$9K |
| D4341 |
|
54 |
16 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
56 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
395 |
357 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
432 |
426 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
25 |
$284.83 |