| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
566 |
368 |
$209K |
| D1110 |
Prophylaxis - adult |
1,466 |
1,449 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
920 |
892 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
732 |
$39K |
| D0330 |
Panoramic radiographic image |
887 |
876 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,725 |
1,704 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,340 |
1,320 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
107 |
$26K |
| D2950 |
|
209 |
161 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
76 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,392 |
1,360 |
$15K |
| D1206 |
Topical application of fluoride varnish |
506 |
506 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
565 |
562 |
$12K |
| D1120 |
Prophylaxis - child |
137 |
136 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
619 |
611 |
$6K |
| D1330 |
|
18 |
18 |
$108.00 |