| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
186 |
103 |
$68K |
| D9310 |
|
853 |
853 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,188 |
2,045 |
$40K |
| D0366 |
|
87 |
87 |
$24K |
| D0365 |
|
86 |
86 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
1,805 |
1,803 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,080 |
2,078 |
$19K |
| D0330 |
Panoramic radiographic image |
714 |
714 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,753 |
1,749 |
$17K |
| D0364 |
|
43 |
43 |
$12K |
| D2954 |
|
129 |
99 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
336 |
336 |
$6K |
| D1110 |
Prophylaxis - adult |
117 |
117 |
$4K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$287.58 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$246.56 |