| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
175 |
106 |
$69K |
| D1110 |
Prophylaxis - adult |
504 |
494 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
478 |
474 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
237 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
190 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
80 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
67 |
$3K |
| D1120 |
Prophylaxis - child |
55 |
55 |
$2K |
| D2950 |
|
61 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
48 |
47 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
359 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$975.00 |
| D0274 |
Bitewings - four radiographic images |
61 |
59 |
$703.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
48 |
$204.00 |