| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
209 |
159 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
693 |
337 |
$56K |
| D1110 |
Prophylaxis - adult |
1,516 |
1,487 |
$51K |
| D2950 |
|
262 |
209 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,098 |
1,079 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,387 |
1,365 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
760 |
745 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
91 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
405 |
361 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
567 |
526 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
444 |
439 |
$8K |
| D4341 |
|
81 |
24 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
36 |
$7K |
| D0330 |
Panoramic radiographic image |
127 |
122 |
$6K |
| D1120 |
Prophylaxis - child |
138 |
138 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
412 |
400 |
$3K |