| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
1,127 |
966 |
$73K |
| D1110 |
Prophylaxis - adult |
1,179 |
1,158 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
412 |
190 |
$42K |
| D0330 |
Panoramic radiographic image |
696 |
684 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,248 |
1,225 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
115 |
$27K |
| D0274 |
Bitewings - four radiographic images |
918 |
903 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
630 |
$27K |
| D1206 |
Topical application of fluoride varnish |
602 |
592 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
24 |
12 |
$12K |
| D0460 |
|
295 |
279 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
188 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
173 |
166 |
$6K |
| D1120 |
Prophylaxis - child |
131 |
125 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
408 |
403 |
$5K |
| D2950 |
|
23 |
13 |
$3K |