| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,641 |
2,608 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
2,713 |
2,685 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,116 |
1,109 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,866 |
1,776 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
419 |
408 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
41 |
24 |
$29K |
| D0274 |
Bitewings - four radiographic images |
656 |
643 |
$24K |
| D1120 |
Prophylaxis - child |
388 |
384 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,331 |
1,152 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
115 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
281 |
$12K |
| D9110 |
|
142 |
133 |
$6K |
| D2394 |
|
38 |
25 |
$4K |
| D2335 |
|
15 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$1K |
| D0180 |
|
12 |
12 |
$444.00 |