| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
411 |
260 |
$294K |
| D0140 |
Limited oral evaluation - problem focused |
3,014 |
2,949 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
141 |
94 |
$80K |
| D1110 |
Prophylaxis - adult |
1,469 |
1,448 |
$78K |
| D0274 |
Bitewings - four radiographic images |
993 |
982 |
$35K |
| D0330 |
Panoramic radiographic image |
251 |
248 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
959 |
897 |
$13K |
| D2954 |
|
68 |
52 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
499 |
488 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
13 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
66 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
174 |
$8K |
| D1206 |
Topical application of fluoride varnish |
199 |
199 |
$5K |
| D1120 |
Prophylaxis - child |
86 |
86 |
$4K |
| D7311 |
|
18 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
102 |
$2K |
| D0272 |
Bitewings - two radiographic images |
62 |
61 |
$868.00 |
| D9110 |
|
13 |
13 |
$455.00 |
| D1999 |
|
26 |
23 |
$0.00 |