| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
78 |
44 |
$64K |
| D4910 |
|
788 |
785 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,483 |
1,481 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,009 |
1,007 |
$22K |
| D0274 |
Bitewings - four radiographic images |
686 |
686 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
413 |
412 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,197 |
1,191 |
$15K |
| D1110 |
Prophylaxis - adult |
296 |
296 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
48 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
40 |
$9K |
| D2950 |
|
64 |
40 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
69 |
$5K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$579.48 |