| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
440 |
233 |
$314K |
| D1110 |
Prophylaxis - adult |
1,461 |
1,446 |
$80K |
| D2950 |
|
252 |
176 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
973 |
893 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
458 |
449 |
$35K |
| D1354 |
|
2,301 |
243 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,424 |
1,386 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
701 |
$32K |
| D0274 |
Bitewings - four radiographic images |
672 |
665 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,278 |
1,202 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,457 |
1,046 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
333 |
332 |
$10K |
| D2954 |
|
49 |
33 |
$10K |
| D9110 |
|
92 |
85 |
$3K |
| D1120 |
Prophylaxis - child |
62 |
62 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$953.00 |
| D0180 |
|
14 |
14 |
$523.00 |