| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,141 |
1,109 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
969 |
944 |
$40K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
46 |
26 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
373 |
372 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
178 |
$7K |
| D0274 |
Bitewings - four radiographic images |
262 |
255 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
474 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
56 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
195 |
$1K |
| D1206 |
Topical application of fluoride varnish |
61 |
61 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
53 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$966.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
72 |
$914.40 |
| D2950 |
|
23 |
14 |
$862.50 |
| D0601 |
|
12 |
12 |
$120.00 |