| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
212 |
108 |
$148K |
| D1110 |
Prophylaxis - adult |
663 |
606 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
527 |
484 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
645 |
596 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
334 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
380 |
351 |
$12K |
| D0330 |
Panoramic radiographic image |
426 |
395 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
296 |
$7K |
| D2954 |
|
41 |
27 |
$6K |
| D0274 |
Bitewings - four radiographic images |
419 |
386 |
$4K |
| D4341 |
|
54 |
13 |
$4K |
| D4355 |
|
30 |
28 |
$3K |
| D1206 |
Topical application of fluoride varnish |
54 |
52 |
$2K |
| D4910 |
|
40 |
39 |
$2K |
| D2950 |
|
26 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
50 |
45 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
423 |
307 |
$1K |