| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
401 |
191 |
$273K |
| D1110 |
Prophylaxis - adult |
2,742 |
2,724 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,637 |
2,611 |
$71K |
| D2950 |
|
379 |
213 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
631 |
355 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
987 |
953 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
492 |
164 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,726 |
1,713 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,727 |
1,705 |
$34K |
| D0330 |
Panoramic radiographic image |
955 |
939 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
591 |
199 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
556 |
544 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,395 |
1,361 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
166 |
92 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
76 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
675 |
669 |
$10K |
| D1120 |
Prophylaxis - child |
206 |
205 |
$8K |
| D2394 |
|
64 |
32 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
692 |
487 |
$4K |
| D4355 |
|
17 |
17 |
$846.93 |
| D0270 |
|
15 |
15 |
$181.31 |