| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
244 |
173 |
$131K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
567 |
222 |
$75K |
| D1110 |
Prophylaxis - adult |
1,790 |
1,725 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
987 |
336 |
$65K |
| D0330 |
Panoramic radiographic image |
1,360 |
1,306 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,044 |
1,994 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,870 |
1,814 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,438 |
1,385 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
920 |
873 |
$24K |
| D1120 |
Prophylaxis - child |
701 |
684 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
105 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
533 |
512 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
100 |
$10K |
| D3320 |
|
16 |
15 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
363 |
$4K |
| D0272 |
Bitewings - two radiographic images |
134 |
131 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
27 |
$1K |