| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
937 |
322 |
$628K |
| D2950 |
|
940 |
338 |
$166K |
| D1110 |
Prophylaxis - adult |
960 |
960 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
510 |
509 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
649 |
649 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
922 |
922 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
530 |
528 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,078 |
1,059 |
$18K |
| D1120 |
Prophylaxis - child |
310 |
310 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
484 |
484 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
596 |
492 |
$6K |
| D0274 |
Bitewings - four radiographic images |
130 |
130 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
12 |
$4K |
| D0240 |
|
28 |
14 |
$615.60 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$353.94 |