| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,354 |
3,278 |
$170K |
| D2740 |
Crown - porcelain/ceramic |
238 |
139 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
3,199 |
3,137 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,944 |
1,894 |
$66K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
101 |
68 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
480 |
461 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
347 |
343 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
746 |
691 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
105 |
$8K |
| D0330 |
Panoramic radiographic image |
116 |
114 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
257 |
255 |
$6K |
| D2950 |
|
26 |
13 |
$4K |
| D4341 |
|
31 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
98 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$605.00 |
| D1330 |
|
12 |
12 |
$0.00 |