| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
960 |
449 |
$672K |
| D1110 |
Prophylaxis - adult |
1,095 |
1,060 |
$60K |
| D2950 |
|
371 |
196 |
$59K |
| D2954 |
|
302 |
168 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,172 |
1,133 |
$41K |
| D0330 |
Panoramic radiographic image |
885 |
845 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
490 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,371 |
1,118 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
695 |
677 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
225 |
$10K |
| D1120 |
Prophylaxis - child |
120 |
115 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
186 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
28 |
$4K |
| D7311 |
|
26 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
351 |
215 |
$3K |
| D1351 |
Sealant - per tooth |
64 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$384.00 |
| D1204 |
|
12 |
12 |
$0.00 |