| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,002 |
996 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
741 |
737 |
$34K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
55 |
41 |
$26K |
| D4910 |
|
136 |
136 |
$10K |
| D4341 |
|
115 |
32 |
$8K |
| D9430 |
|
272 |
255 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
96 |
96 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$6K |
| D0350 |
|
841 |
247 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,349 |
385 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
40 |
$4K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
134 |
$2K |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$928.20 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$345.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$229.00 |