| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
298 |
224 |
$178K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,039 |
614 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,155 |
407 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
918 |
844 |
$57K |
| D2950 |
|
326 |
242 |
$39K |
| D1110 |
Prophylaxis - adult |
780 |
741 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,086 |
994 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,074 |
980 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
126 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
402 |
243 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,071 |
1,015 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,326 |
1,179 |
$20K |
| D0274 |
Bitewings - four radiographic images |
550 |
523 |
$18K |
| D4341 |
|
108 |
40 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
12 |
$3K |
| D0270 |
|
198 |
178 |
$3K |
| D1120 |
Prophylaxis - child |
47 |
45 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
144 |
$1K |
| D1206 |
Topical application of fluoride varnish |
50 |
46 |
$991.93 |