| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
89 |
86 |
$58K |
| D1110 |
Prophylaxis - adult |
117 |
117 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
158 |
$5K |
| D2954 |
|
30 |
28 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
141 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
156 |
156 |
$2K |
| D0350 |
|
144 |
144 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
35 |
35 |
$969.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
48 |
$671.30 |
| D0270 |
|
39 |
39 |
$518.28 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$334.08 |