| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
443 |
166 |
$211K |
| D2332 |
|
429 |
144 |
$39K |
| D2954 |
|
362 |
142 |
$38K |
| D9430 |
|
756 |
652 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
322 |
322 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
365 |
119 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
320 |
320 |
$15K |
| D0350 |
|
985 |
267 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,161 |
582 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
51 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
429 |
429 |
$6K |
| D1110 |
Prophylaxis - adult |
60 |
60 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
100 |
100 |
$5K |
| D1320 |
|
209 |
206 |
$3K |
| D1120 |
Prophylaxis - child |
63 |
63 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$426.60 |
| D0270 |
|
28 |
25 |
$140.00 |