| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,354 |
3,087 |
$160K |
| D2740 |
Crown - porcelain/ceramic |
111 |
84 |
$74K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
133 |
116 |
$66K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
112 |
84 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,394 |
2,220 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,301 |
1,199 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,156 |
1,086 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
177 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,134 |
1,038 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
307 |
264 |
$11K |
| D2950 |
|
53 |
43 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
111 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
41 |
$6K |
| D2954 |
|
22 |
17 |
$3K |
| D0270 |
|
261 |
236 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
112 |
108 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
51 |
$705.00 |
| D2940 |
|
24 |
18 |
$0.00 |