| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
220 |
177 |
$133K |
| D1110 |
Prophylaxis - adult |
2,295 |
2,290 |
$100K |
| D0330 |
Panoramic radiographic image |
1,112 |
1,110 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,350 |
1,345 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,558 |
1,552 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,666 |
1,660 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,027 |
2,021 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,349 |
2,153 |
$29K |
| D7240 |
Removal of impacted tooth - completely bony |
106 |
37 |
$29K |
| D2950 |
|
153 |
124 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
278 |
272 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
106 |
65 |
$17K |
| D1206 |
Topical application of fluoride varnish |
697 |
697 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183 |
180 |
$4K |
| D0460 |
|
58 |
58 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
29 |
$1K |
| D1120 |
Prophylaxis - child |
16 |
16 |
$570.66 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$314.64 |