| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
238 |
121 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
878 |
429 |
$58K |
| D9430 |
|
1,771 |
1,317 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
740 |
732 |
$48K |
| D1110 |
Prophylaxis - adult |
446 |
440 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
562 |
558 |
$26K |
| D2954 |
|
232 |
118 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,549 |
1,167 |
$18K |
| D0350 |
|
3,004 |
802 |
$17K |
| D0330 |
Panoramic radiographic image |
569 |
554 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,892 |
1,363 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
115 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
83 |
$9K |
| D1120 |
Prophylaxis - child |
176 |
175 |
$9K |
| D1206 |
Topical application of fluoride varnish |
515 |
509 |
$9K |
| D1320 |
|
509 |
507 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
66 |
66 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
15 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
68 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
17 |
$800.00 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$345.60 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$288.00 |