| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
311 |
210 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
884 |
424 |
$66K |
| D1110 |
Prophylaxis - adult |
1,306 |
1,238 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
810 |
789 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,052 |
1,020 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,429 |
1,346 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
296 |
174 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
699 |
648 |
$16K |
| D4342 |
|
426 |
152 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
113 |
$11K |
| D0274 |
Bitewings - four radiographic images |
454 |
428 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
804 |
756 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,082 |
514 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
311 |
$7K |
| D1120 |
Prophylaxis - child |
15 |
15 |
$507.88 |
| D0270 |
|
14 |
13 |
$130.02 |