| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
470 |
305 |
$313K |
| D1110 |
Prophylaxis - adult |
1,812 |
1,760 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,040 |
1,008 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,397 |
1,362 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
686 |
662 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
369 |
$27K |
| D1120 |
Prophylaxis - child |
494 |
483 |
$26K |
| D0274 |
Bitewings - four radiographic images |
727 |
705 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,425 |
1,308 |
$21K |
| D1206 |
Topical application of fluoride varnish |
597 |
586 |
$16K |
| D2950 |
|
91 |
71 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
484 |
329 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
26 |
$4K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$3K |
| D0270 |
|
41 |
37 |
$475.00 |