| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
274 |
151 |
$177K |
| D1110 |
Prophylaxis - adult |
1,906 |
1,658 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,537 |
1,354 |
$31K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
26 |
15 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
146 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
162 |
64 |
$10K |
| D0274 |
Bitewings - four radiographic images |
301 |
251 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
141 |
$6K |
| D2950 |
|
21 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
43 |
$657.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$469.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
12 |
$179.00 |
| D1999 |
|
251 |
206 |
$0.00 |