| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
170 |
99 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
816 |
814 |
$54K |
| D4341 |
|
344 |
89 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
473 |
467 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
158 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
41 |
19 |
$20K |
| D1110 |
Prophylaxis - adult |
194 |
194 |
$17K |
| D0330 |
Panoramic radiographic image |
271 |
269 |
$8K |
| D9430 |
|
124 |
115 |
$4K |
| D4910 |
|
48 |
48 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
15 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
132 |
132 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$200.00 |