| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
319 |
225 |
$221K |
| D1110 |
Prophylaxis - adult |
3,195 |
3,158 |
$166K |
| D2950 |
|
323 |
240 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,140 |
2,116 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
345 |
169 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
546 |
536 |
$38K |
| D0274 |
Bitewings - four radiographic images |
875 |
868 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
447 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,199 |
1,155 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
381 |
374 |
$15K |
| D1120 |
Prophylaxis - child |
271 |
268 |
$13K |
| D1206 |
Topical application of fluoride varnish |
451 |
448 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
70 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D2394 |
|
13 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$830.00 |