| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
361 |
142 |
$212K |
| D0220 |
Intraoral - periapical first radiographic image |
1,392 |
1,239 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
682 |
629 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
405 |
397 |
$27K |
| D2950 |
|
243 |
103 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
325 |
325 |
$19K |
| D0274 |
Bitewings - four radiographic images |
685 |
677 |
$19K |
| D1110 |
Prophylaxis - adult |
203 |
201 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
27 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
929 |
454 |
$9K |
| D0330 |
Panoramic radiographic image |
193 |
188 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
16 |
$3K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$257.28 |
| D1120 |
Prophylaxis - child |
71 |
71 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$0.00 |