| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
80 |
59 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
412 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
232 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
79 |
$10K |
| D0350 |
|
927 |
286 |
$9K |
| D1206 |
Topical application of fluoride varnish |
432 |
431 |
$7K |
| D1110 |
Prophylaxis - adult |
78 |
78 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
51 |
$6K |
| D2954 |
|
54 |
40 |
$6K |
| D1120 |
Prophylaxis - child |
73 |
73 |
$4K |
| D9430 |
|
80 |
74 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
585 |
193 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$518.40 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
12 |
$168.00 |