| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
942 |
885 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
842 |
802 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
19 |
12 |
$13K |
| D0274 |
Bitewings - four radiographic images |
378 |
364 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
71 |
$9K |
| D8670 |
Periodic orthodontic treatment visit |
16 |
16 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
245 |
231 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
83 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
32 |
$2K |
| D8660 |
|
17 |
17 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
89 |
66 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
40 |
$1K |
| D9310 |
|
16 |
16 |
$945.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$659.72 |