| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
663 |
361 |
$466K |
| D1110 |
Prophylaxis - adult |
2,970 |
2,912 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
834 |
814 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,284 |
1,262 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,996 |
1,949 |
$45K |
| D2950 |
|
224 |
156 |
$37K |
| D0274 |
Bitewings - four radiographic images |
910 |
890 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
160 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
12 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
362 |
356 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
40 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
519 |
499 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
63 |
$6K |
| D9110 |
|
127 |
127 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
26 |
$5K |
| D1351 |
Sealant - per tooth |
54 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
14 |
$528.00 |