| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
601 |
331 |
$405K |
| D2950 |
|
587 |
353 |
$87K |
| D1110 |
Prophylaxis - adult |
848 |
820 |
$46K |
| D4341 |
|
341 |
130 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
721 |
686 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
623 |
585 |
$23K |
| D0330 |
Panoramic radiographic image |
529 |
495 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
239 |
112 |
$21K |
| D0274 |
Bitewings - four radiographic images |
652 |
631 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
64 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
85 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
966 |
866 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
632 |
400 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
42 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
173 |
170 |
$4K |
| D3120 |
|
131 |
82 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
43 |
$3K |
| D9110 |
|
63 |
56 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
69 |
$2K |
| D1120 |
Prophylaxis - child |
37 |
37 |
$2K |
| D0180 |
|
21 |
20 |
$766.00 |
| D1206 |
Topical application of fluoride varnish |
29 |
26 |
$644.00 |
| D0272 |
Bitewings - two radiographic images |
33 |
31 |
$482.00 |
| D0270 |
|
44 |
42 |
$454.00 |
| D1330 |
|
13 |
13 |
$0.00 |