| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,938 |
2,864 |
$159K |
| D2740 |
Crown - porcelain/ceramic |
160 |
122 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,987 |
2,909 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
778 |
516 |
$60K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
96 |
77 |
$52K |
| D0330 |
Panoramic radiographic image |
1,007 |
964 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,097 |
1,058 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,799 |
1,764 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
963 |
937 |
$38K |
| D2335 |
|
258 |
142 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
205 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
539 |
531 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
915 |
844 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$3K |
| D2950 |
|
16 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$770.00 |