| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
499 |
352 |
$353K |
| D1110 |
Prophylaxis - adult |
5,276 |
5,233 |
$276K |
| D0120 |
Periodic oral evaluation - established patient |
5,021 |
4,975 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,124 |
2,103 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
466 |
228 |
$66K |
| D1120 |
Prophylaxis - child |
1,348 |
1,337 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,512 |
1,487 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
739 |
736 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,807 |
1,793 |
$45K |
| D2950 |
|
234 |
181 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
788 |
785 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
438 |
348 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,566 |
1,524 |
$23K |
| D0272 |
Bitewings - two radiographic images |
129 |
125 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
30 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$779.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
40 |
$596.92 |