| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
321 |
191 |
$181K |
| D1110 |
Prophylaxis - adult |
3,499 |
2,511 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
2,322 |
1,667 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,371 |
967 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
638 |
291 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,077 |
803 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
537 |
393 |
$29K |
| D2950 |
|
237 |
117 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,812 |
1,263 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,336 |
876 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
286 |
113 |
$11K |
| D3120 |
|
440 |
196 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
304 |
206 |
$6K |
| D1120 |
Prophylaxis - child |
46 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
29 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$700.00 |
| D1999 |
|
24 |
17 |
$0.00 |