| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,574 |
3,338 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
3,646 |
3,445 |
$79K |
| D2740 |
Crown - porcelain/ceramic |
110 |
55 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,670 |
1,553 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
344 |
$51K |
| D1120 |
Prophylaxis - child |
882 |
849 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,075 |
1,045 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
466 |
414 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
184 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
12 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
109 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
276 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
26 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
13 |
$815.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$322.00 |
| D1330 |
|
63 |
63 |
$0.00 |