| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
649 |
423 |
$428K |
| D1110 |
Prophylaxis - adult |
4,534 |
4,261 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,000 |
746 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
3,899 |
3,690 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,268 |
2,133 |
$75K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
72 |
55 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
846 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
948 |
890 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
469 |
215 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
350 |
135 |
$27K |
| D2950 |
|
184 |
131 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
343 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
908 |
862 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,500 |
1,386 |
$20K |
| D1120 |
Prophylaxis - child |
380 |
376 |
$17K |
| D4342 |
|
144 |
65 |
$11K |
| D0330 |
Panoramic radiographic image |
37 |
36 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
58 |
$1K |