| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
296 |
171 |
$134K |
| D1110 |
Prophylaxis - adult |
781 |
778 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
183 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
144 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
752 |
752 |
$18K |
| D2950 |
|
125 |
93 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
91 |
$14K |
| D0274 |
Bitewings - four radiographic images |
515 |
515 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
307 |
300 |
$11K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$5K |
| D1120 |
Prophylaxis - child |
118 |
118 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
138 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
81 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
200 |
182 |
$3K |