| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
346 |
253 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,275 |
1,272 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,129 |
1,127 |
$52K |
| D1110 |
Prophylaxis - adult |
588 |
576 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
675 |
665 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
375 |
230 |
$44K |
| D9430 |
|
1,006 |
937 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,316 |
1,300 |
$18K |
| D1120 |
Prophylaxis - child |
400 |
400 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
125 |
$16K |
| D0274 |
Bitewings - four radiographic images |
642 |
632 |
$13K |
| D4910 |
|
146 |
141 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
928 |
879 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,685 |
1,621 |
$11K |
| D4341 |
|
148 |
55 |
$10K |
| D2954 |
|
81 |
58 |
$9K |
| D0350 |
|
874 |
313 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
38 |
$3K |