| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
271 |
185 |
$217K |
| D1110 |
Prophylaxis - adult |
3,350 |
3,301 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,873 |
877 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,303 |
3,262 |
$62K |
| D2950 |
|
379 |
253 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,652 |
1,630 |
$37K |
| D0330 |
Panoramic radiographic image |
603 |
587 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
976 |
949 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
399 |
222 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
746 |
725 |
$19K |
| D1120 |
Prophylaxis - child |
798 |
781 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
823 |
805 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,864 |
1,812 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
691 |
467 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
64 |
$5K |
| D0272 |
Bitewings - two radiographic images |
314 |
303 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
13 |
$1K |
| D1320 |
|
91 |
88 |
$1K |