| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
131 |
112 |
$78K |
| D1110 |
Prophylaxis - adult |
864 |
801 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
176 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
670 |
600 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
593 |
554 |
$19K |
| D0274 |
Bitewings - four radiographic images |
399 |
376 |
$13K |
| D2950 |
|
79 |
70 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
479 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
361 |
344 |
$9K |
| D0270 |
|
187 |
165 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$3K |
| D3120 |
|
91 |
65 |
$3K |