| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
968 |
387 |
$661K |
| D2950 |
|
865 |
374 |
$131K |
| D1110 |
Prophylaxis - adult |
685 |
660 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
464 |
443 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
264 |
249 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
250 |
245 |
$6K |
| D0274 |
Bitewings - four radiographic images |
167 |
161 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
120 |
$5K |
| D0330 |
Panoramic radiographic image |
68 |
62 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
145 |
136 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$660.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$336.00 |
| D1330 |
|
228 |
213 |
$0.00 |