| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
217 |
122 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,394 |
1,393 |
$86K |
| D1110 |
Prophylaxis - adult |
967 |
966 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
816 |
502 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
585 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,451 |
1,582 |
$34K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
50 |
29 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
488 |
488 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,244 |
1,236 |
$20K |
| D4341 |
|
176 |
50 |
$12K |
| D0272 |
Bitewings - two radiographic images |
958 |
956 |
$11K |
| D2160 |
|
118 |
88 |
$9K |
| D4910 |
|
102 |
95 |
$8K |
| D0350 |
|
795 |
427 |
$7K |
| D2954 |
|
69 |
51 |
$7K |
| D1120 |
Prophylaxis - child |
207 |
202 |
$7K |
| D2140 |
|
97 |
64 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
375 |
370 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
186 |
186 |
$3K |
| D9430 |
|
41 |
41 |
$1K |