| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
185 |
150 |
$131K |
| D1110 |
Prophylaxis - adult |
2,287 |
2,221 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
2,098 |
2,067 |
$47K |
| D0274 |
Bitewings - four radiographic images |
687 |
671 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
24 |
24 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
318 |
311 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
54 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
211 |
$3K |
| D1120 |
Prophylaxis - child |
42 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
24 |
$1K |