| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
272 |
187 |
$185K |
| D1110 |
Prophylaxis - adult |
1,011 |
1,010 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
767 |
767 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,098 |
1,065 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
348 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
66 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
196 |
196 |
$8K |
| D0274 |
Bitewings - four radiographic images |
222 |
221 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
26 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
591 |
357 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
63 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
25 |
$3K |
| D2950 |
|
13 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
69 |
69 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
66 |
66 |
$1K |
| D1120 |
Prophylaxis - child |
38 |
38 |
$1K |