| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
321 |
149 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
144 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
26 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
274 |
$4K |
| D9310 |
|
29 |
29 |
$3K |
| D1110 |
Prophylaxis - adult |
64 |
64 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
136 |
136 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$188.89 |
| D9994 |
|
43 |
43 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$0.00 |
| D4910 |
|
72 |
72 |
$0.00 |
| D2950 |
|
237 |
112 |
$0.00 |