| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,920 |
1,864 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,083 |
2,028 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,332 |
1,299 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
1,710 |
1,640 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
668 |
661 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,427 |
1,191 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
15 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
64 |
$7K |
| D1120 |
Prophylaxis - child |
136 |
135 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
68 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
19 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
38 |
$1K |