| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
518 |
130 |
$66K |
| D2740 |
Crown - porcelain/ceramic |
79 |
40 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
29 |
$21K |
| D5213 |
|
13 |
13 |
$13K |
| D5214 |
|
12 |
12 |
$12K |
| D2950 |
|
72 |
39 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
44 |
$8K |
| D2394 |
|
42 |
32 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
37 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
120 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
17 |
$3K |
| D0470 |
|
58 |
55 |
$2K |
| D0274 |
Bitewings - four radiographic images |
44 |
43 |
$2K |
| D7311 |
|
15 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$695.18 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$604.20 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
42 |
$422.69 |
| D0350 |
|
13 |
13 |
$305.76 |