| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
741 |
584 |
$500K |
| D0140 |
Limited oral evaluation - problem focused |
1,564 |
1,541 |
$91K |
| D1110 |
Prophylaxis - adult |
1,077 |
1,072 |
$65K |
| D0330 |
Panoramic radiographic image |
1,338 |
1,331 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,439 |
1,430 |
$50K |
| D2394 |
|
307 |
199 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
406 |
197 |
$34K |
| D2954 |
|
258 |
201 |
$30K |
| D1120 |
Prophylaxis - child |
448 |
445 |
$27K |
| D2950 |
|
393 |
306 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
373 |
178 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
483 |
480 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
308 |
$9K |
| D0272 |
Bitewings - two radiographic images |
713 |
707 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
148 |
$900.00 |