| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,249 |
430 |
$805K |
| D2950 |
|
590 |
207 |
$89K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
201 |
84 |
$80K |
| D1110 |
Prophylaxis - adult |
1,617 |
1,488 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,396 |
1,277 |
$28K |
| D9110 |
|
777 |
583 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
567 |
546 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,728 |
1,520 |
$23K |
| D0274 |
Bitewings - four radiographic images |
496 |
472 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
399 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
226 |
214 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,359 |
1,024 |
$14K |
| D1206 |
Topical application of fluoride varnish |
414 |
401 |
$9K |
| D2954 |
|
75 |
27 |
$8K |
| D1120 |
Prophylaxis - child |
83 |
80 |
$4K |