| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,375 |
2,312 |
$122K |
| D2740 |
Crown - porcelain/ceramic |
77 |
51 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
675 |
380 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,059 |
2,016 |
$45K |
| D0274 |
Bitewings - four radiographic images |
784 |
770 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
181 |
120 |
$15K |
| D2950 |
|
85 |
56 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
137 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
226 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
590 |
577 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
592 |
370 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
96 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$960.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$567.00 |
| D1206 |
Topical application of fluoride varnish |
21 |
19 |
$494.00 |