| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
138 |
105 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
745 |
729 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
936 |
917 |
$40K |
| D1110 |
Prophylaxis - adult |
583 |
574 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
372 |
133 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
467 |
455 |
$19K |
| D4342 |
|
188 |
68 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
808 |
788 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
99 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
81 |
$9K |
| D0274 |
Bitewings - four radiographic images |
199 |
197 |
$8K |
| D2950 |
|
43 |
37 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
251 |
246 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
190 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
411 |
372 |
$6K |
| D1120 |
Prophylaxis - child |
74 |
72 |
$4K |