| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,267 |
777 |
$1.06M |
| D1110 |
Prophylaxis - adult |
8,703 |
8,702 |
$532K |
| D0120 |
Periodic oral evaluation - established patient |
6,752 |
6,752 |
$207K |
| D2954 |
|
959 |
672 |
$161K |
| D0274 |
Bitewings - four radiographic images |
4,223 |
4,221 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,564 |
3,561 |
$119K |
| D3320 |
|
205 |
171 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
2,209 |
2,185 |
$58K |
| D0330 |
Panoramic radiographic image |
1,232 |
1,232 |
$42K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
35 |
$35K |
| D1120 |
Prophylaxis - child |
645 |
645 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,885 |
1,871 |
$28K |
| D3310 |
|
53 |
36 |
$19K |
| D2752 |
|
14 |
13 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
619 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
51 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
242 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
22 |
$4K |
| D1206 |
Topical application of fluoride varnish |
65 |
65 |
$2K |
| D0272 |
Bitewings - two radiographic images |
95 |
95 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
13 |
$775.50 |
| D1330 |
|
27 |
27 |
$0.00 |
| D1999 |
|
108 |
107 |
$0.00 |