| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
316 |
191 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,306 |
668 |
$120K |
| D2950 |
|
330 |
199 |
$48K |
| D1110 |
Prophylaxis - adult |
1,057 |
1,047 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
277 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,309 |
1,299 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
677 |
664 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
834 |
$30K |
| D1120 |
Prophylaxis - child |
581 |
569 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
606 |
584 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
492 |
482 |
$11K |
| D0274 |
Bitewings - four radiographic images |
342 |
340 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
585 |
570 |
$8K |
| D1206 |
Topical application of fluoride varnish |
187 |
184 |
$5K |
| D4355 |
|
79 |
79 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
408 |
220 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$325.00 |