| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
274 |
$18K |
| D1110 |
Prophylaxis - adult |
183 |
182 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
28 |
24 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
220 |
$10K |
| D0350 |
|
721 |
161 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
111 |
110 |
$2K |
| D2952 |
|
14 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$214.65 |
| D1999 |
|
18 |
18 |
$0.00 |