| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
486 |
370 |
$284K |
| D0367 |
|
335 |
299 |
$87K |
| D2950 |
|
467 |
354 |
$57K |
| D9243 |
|
174 |
132 |
$48K |
| D1110 |
Prophylaxis - adult |
845 |
773 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
131 |
$30K |
| D4910 |
|
453 |
411 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
248 |
66 |
$26K |
| D0274 |
Bitewings - four radiographic images |
666 |
594 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
915 |
850 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
613 |
559 |
$20K |
| D1206 |
Topical application of fluoride varnish |
854 |
782 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
802 |
705 |
$13K |
| D9612 |
|
136 |
131 |
$12K |
| D9239 |
|
133 |
128 |
$11K |
| D4341 |
|
61 |
26 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
282 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
40 |
$8K |
| D0270 |
|
445 |
420 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
39 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
497 |
151 |
$4K |
| D0330 |
Panoramic radiographic image |
27 |
16 |
$908.32 |
| D0350 |
|
153 |
151 |
$704.04 |