| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
146 |
103 |
$97K |
| D1110 |
Prophylaxis - adult |
948 |
845 |
$39K |
| D0330 |
Panoramic radiographic image |
675 |
620 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
978 |
909 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
574 |
488 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
642 |
$16K |
| D0274 |
Bitewings - four radiographic images |
801 |
726 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
96 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
436 |
397 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
298 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
848 |
608 |
$8K |
| D1120 |
Prophylaxis - child |
106 |
100 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
26 |
$3K |
| D9110 |
|
13 |
13 |
$661.24 |
| D0272 |
Bitewings - two radiographic images |
19 |
14 |
$178.80 |