| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
162 |
111 |
$104K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
122 |
85 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,185 |
1,158 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
332 |
210 |
$21K |
| D9110 |
|
551 |
514 |
$19K |
| D2954 |
|
63 |
51 |
$10K |
| D0274 |
Bitewings - four radiographic images |
272 |
268 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
72 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
368 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
43 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$1K |