| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,049 |
483 |
$677K |
| D1110 |
Prophylaxis - adult |
3,321 |
2,515 |
$133K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
209 |
103 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,240 |
557 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,226 |
1,697 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,568 |
1,977 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,610 |
2,559 |
$41K |
| D2950 |
|
279 |
171 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,220 |
973 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
850 |
569 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,461 |
1,656 |
$23K |
| D0180 |
|
568 |
501 |
$19K |
| D0330 |
Panoramic radiographic image |
536 |
282 |
$15K |
| D9110 |
|
429 |
368 |
$14K |
| D1206 |
Topical application of fluoride varnish |
491 |
388 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
112 |
$10K |
| D1120 |
Prophylaxis - child |
186 |
129 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
29 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
27 |
$3K |
| D0270 |
|
350 |
234 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$384.00 |
| D9450 |
|
172 |
135 |
$0.00 |