| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,418 |
2,366 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
2,412 |
2,370 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,259 |
1,234 |
$44K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
61 |
40 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
154 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
211 |
153 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
224 |
221 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
963 |
930 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
20 |
12 |
$15K |
| D1120 |
Prophylaxis - child |
293 |
290 |
$14K |
| D1206 |
Topical application of fluoride varnish |
460 |
454 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
669 |
515 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
209 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
143 |
$6K |
| D0180 |
|
138 |
135 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
60 |
$2K |
| D2394 |
|
18 |
12 |
$1K |
| D1330 |
|
20 |
19 |
$0.00 |