| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
285 |
213 |
$206K |
| D1110 |
Prophylaxis - adult |
1,141 |
1,096 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
628 |
591 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
262 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
888 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
576 |
$24K |
| D2950 |
|
98 |
76 |
$16K |
| D0274 |
Bitewings - four radiographic images |
440 |
428 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
108 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
225 |
111 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
516 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
745 |
675 |
$11K |
| D2335 |
|
44 |
26 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
240 |
$4K |
| D1120 |
Prophylaxis - child |
43 |
42 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$980.00 |
| D0330 |
Panoramic radiographic image |
16 |
14 |
$917.00 |
| D0270 |
|
29 |
28 |
$401.00 |