| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
582 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
39 |
24 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
388 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
80 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
42 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
43 |
43 |
$2K |
| D9430 |
|
82 |
74 |
$2K |
| D1120 |
Prophylaxis - child |
47 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
200 |
92 |
$751.20 |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
56 |
$478.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
35 |
$341.00 |
| D0274 |
Bitewings - four radiographic images |
15 |
14 |
$212.40 |