| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
103 |
71 |
$73K |
| D1110 |
Prophylaxis - adult |
571 |
543 |
$30K |
| D0330 |
Panoramic radiographic image |
615 |
592 |
$29K |
| D0274 |
Bitewings - four radiographic images |
830 |
797 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
559 |
538 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
405 |
387 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
110 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
824 |
767 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
69 |
$9K |
| D2950 |
|
58 |
39 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
26 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
269 |
257 |
$6K |
| D3120 |
|
114 |
78 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
162 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
62 |
$2K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$1K |