| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
3,081 |
476 |
$528K |
| D2335 |
|
1,953 |
324 |
$340K |
| D1110 |
Prophylaxis - adult |
842 |
830 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
106 |
46 |
$42K |
| D1206 |
Topical application of fluoride varnish |
998 |
986 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
477 |
343 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
377 |
$19K |
| D9248 |
|
100 |
85 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
613 |
608 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,167 |
972 |
$13K |
| D0274 |
Bitewings - four radiographic images |
499 |
490 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
24 |
$9K |
| D2950 |
|
105 |
46 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
790 |
716 |
$6K |
| D1120 |
Prophylaxis - child |
64 |
64 |
$3K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$2K |
| D1330 |
|
16 |
16 |
$96.00 |