| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,502 |
6,427 |
$245K |
| D0120 |
Periodic oral evaluation - established patient |
6,455 |
6,367 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,782 |
4,719 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,286 |
2,257 |
$58K |
| D0330 |
Panoramic radiographic image |
1,255 |
1,233 |
$54K |
| D1120 |
Prophylaxis - child |
1,539 |
1,515 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,486 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
240 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
269 |
195 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
527 |
512 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
32 |
28 |
$13K |
| D2140 |
|
82 |
55 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
39 |
$3K |
| D2331 |
|
46 |
27 |
$2K |
| D0601 |
|
141 |
140 |
$515.00 |
| D0603 |
|
69 |
66 |
$260.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$135.00 |
| D1999 |
|
1,525 |
1,351 |
$0.00 |