| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,901 |
1,711 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,257 |
2,038 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,108 |
985 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
114 |
$20K |
| D1206 |
Topical application of fluoride varnish |
947 |
866 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
773 |
656 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
345 |
304 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$7K |
| D0330 |
Panoramic radiographic image |
87 |
85 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
84 |
$3K |
| D1120 |
Prophylaxis - child |
56 |
54 |
$2K |
| D4910 |
|
27 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
14 |
$1K |
| D1999 |
|
626 |
534 |
$408.00 |