| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,224 |
3,028 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
3,612 |
3,381 |
$82K |
| D0274 |
Bitewings - four radiographic images |
1,800 |
1,682 |
$63K |
| D2740 |
Crown - porcelain/ceramic |
58 |
42 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,311 |
2,131 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,065 |
1,009 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
53 |
42 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,014 |
1,751 |
$25K |
| D1120 |
Prophylaxis - child |
395 |
377 |
$19K |
| D0330 |
Panoramic radiographic image |
278 |
225 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
26 |
$1K |
| D1999 |
|
22 |
21 |
$0.00 |