| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,353 |
1,331 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,168 |
2,092 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,133 |
2,058 |
$34K |
| D9630 |
|
2,057 |
2,012 |
$34K |
| D1120 |
Prophylaxis - child |
1,005 |
985 |
$29K |
| D0274 |
Bitewings - four radiographic images |
880 |
869 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,741 |
1,658 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,612 |
1,531 |
$15K |
| D9920 |
|
205 |
191 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
115 |
66 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
400 |
394 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
29 |
$5K |
| D0330 |
Panoramic radiographic image |
52 |
52 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
161 |
$2K |
| D0272 |
Bitewings - two radiographic images |
56 |
55 |
$1K |
| D2740 |
Crown - porcelain/ceramic |
23 |
12 |
$0.00 |