| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,224 |
1,199 |
$1.49M |
| D2950 |
|
2,123 |
1,244 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,579 |
954 |
$214K |
| D0210 |
Intraoral - complete series of radiographic images |
2,363 |
2,352 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,327 |
418 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,814 |
2,808 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
562 |
378 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
604 |
307 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
319 |
188 |
$53K |
| D1110 |
Prophylaxis - adult |
963 |
960 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
710 |
708 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
488 |
484 |
$21K |
| D4342 |
|
154 |
68 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,112 |
1,104 |
$14K |
| D3320 |
|
34 |
25 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
126 |
125 |
$4K |
| D2335 |
|
20 |
12 |
$4K |
| D2394 |
|
14 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$1K |