| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
928 |
524 |
$368K |
| D1110 |
Prophylaxis - adult |
1,312 |
1,264 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,446 |
1,386 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
965 |
901 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,577 |
1,521 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,631 |
2,480 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,222 |
2,068 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
321 |
321 |
$7K |
| D2954 |
|
63 |
51 |
$5K |
| D0330 |
Panoramic radiographic image |
239 |
212 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
119 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$862.00 |
| D1206 |
Topical application of fluoride varnish |
59 |
54 |
$330.00 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$278.25 |