| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
280 |
139 |
$108K |
| D2394 |
|
331 |
153 |
$36K |
| D2950 |
|
215 |
124 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
253 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
447 |
440 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
104 |
73 |
$11K |
| D1206 |
Topical application of fluoride varnish |
324 |
316 |
$8K |
| D1110 |
Prophylaxis - adult |
184 |
181 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
263 |
$7K |
| D0330 |
Panoramic radiographic image |
174 |
173 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
29 |
$5K |
| D0274 |
Bitewings - four radiographic images |
243 |
241 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,382 |
276 |
$4K |
| D4341 |
|
37 |
15 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
13 |
$3K |
| D4355 |
|
42 |
42 |
$3K |
| D2335 |
|
24 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
373 |
345 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
15 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$357.24 |