| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
337 |
236 |
$220K |
| D1110 |
Prophylaxis - adult |
1,049 |
966 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
180 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
438 |
425 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
180 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
170 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
353 |
$5K |
| D2950 |
|
30 |
25 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
24 |
$4K |
| D2954 |
|
17 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$469.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
37 |
$468.00 |