| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
369 |
132 |
$282K |
| D1110 |
Prophylaxis - adult |
2,466 |
2,453 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
678 |
397 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,300 |
2,285 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,727 |
1,724 |
$51K |
| D2950 |
|
315 |
115 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
174 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
527 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,417 |
1,383 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
619 |
614 |
$16K |
| D0330 |
Panoramic radiographic image |
251 |
251 |
$13K |
| D4910 |
|
96 |
93 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
27 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
89 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
79 |
$2K |
| D1206 |
Topical application of fluoride varnish |
103 |
101 |
$2K |