| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
211 |
176 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
566 |
331 |
$64K |
| D1110 |
Prophylaxis - adult |
641 |
641 |
$32K |
| D2950 |
|
164 |
149 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
766 |
766 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
151 |
$21K |
| D1120 |
Prophylaxis - child |
467 |
467 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
462 |
462 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
137 |
103 |
$18K |
| D1206 |
Topical application of fluoride varnish |
591 |
591 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
369 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
845 |
838 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
197 |
$13K |
| D0274 |
Bitewings - four radiographic images |
297 |
297 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
814 |
795 |
$8K |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$1K |