| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,173 |
383 |
$684K |
| D2950 |
|
1,055 |
340 |
$145K |
| D1110 |
Prophylaxis - adult |
1,448 |
1,327 |
$67K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
154 |
46 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
891 |
753 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,749 |
1,361 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
286 |
258 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
592 |
545 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
684 |
630 |
$14K |
| D4341 |
|
78 |
31 |
$11K |
| D0274 |
Bitewings - four radiographic images |
298 |
268 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
778 |
368 |
$6K |
| D0330 |
Panoramic radiographic image |
72 |
64 |
$4K |
| D0180 |
|
79 |
64 |
$2K |
| D2954 |
|
14 |
12 |
$2K |
| D9110 |
|
28 |
27 |
$985.00 |
| D1120 |
Prophylaxis - child |
28 |
24 |
$793.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
24 |
$691.00 |
| D1999 |
|
62 |
51 |
$0.00 |