| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
772 |
643 |
$120K |
| D2740 |
Crown - porcelain/ceramic |
231 |
126 |
$114K |
| D1110 |
Prophylaxis - adult |
1,954 |
1,954 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
683 |
577 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
450 |
371 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,794 |
1,793 |
$48K |
| D0330 |
Panoramic radiographic image |
1,161 |
1,160 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,111 |
1,110 |
$33K |
| D2335 |
|
138 |
114 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
307 |
$23K |
| D0274 |
Bitewings - four radiographic images |
523 |
523 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
672 |
655 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
69 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
433 |
426 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
25 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
62 |
$1K |