| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
421 |
254 |
$294K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
155 |
78 |
$86K |
| D2950 |
|
398 |
231 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
834 |
809 |
$56K |
| D1110 |
Prophylaxis - adult |
950 |
934 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
967 |
934 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
828 |
805 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,983 |
1,828 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
904 |
888 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,134 |
901 |
$13K |
| D0274 |
Bitewings - four radiographic images |
175 |
175 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
53 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$341.00 |
| D1999 |
|
138 |
124 |
$0.00 |