| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
84 |
63 |
$58K |
| D1110 |
Prophylaxis - adult |
706 |
697 |
$35K |
| D0274 |
Bitewings - four radiographic images |
592 |
587 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
274 |
175 |
$19K |
| D2950 |
|
137 |
103 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
202 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
682 |
677 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
377 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
229 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
109 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
214 |
212 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
404 |
394 |
$5K |
| D1120 |
Prophylaxis - child |
95 |
95 |
$5K |
| D3120 |
|
67 |
35 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
15 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
73 |
$997.00 |
| D0270 |
|
29 |
29 |
$409.00 |