| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
102 |
69 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
519 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
521 |
162 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
416 |
190 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
492 |
492 |
$24K |
| D4341 |
|
328 |
87 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
112 |
37 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
87 |
$13K |
| D1110 |
Prophylaxis - adult |
103 |
103 |
$9K |
| D2332 |
|
102 |
45 |
$8K |
| D0350 |
|
814 |
209 |
$8K |
| D3310 |
|
19 |
12 |
$6K |
| D3320 |
|
13 |
12 |
$5K |
| D2335 |
|
23 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
152 |
152 |
$2K |
| D4342 |
|
43 |
14 |
$2K |
| D2394 |
|
19 |
12 |
$2K |
| D2954 |
|
15 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
19 |
19 |
$997.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
28 |
$660.15 |