| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
787 |
738 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
918 |
867 |
$14K |
| D4910 |
|
199 |
179 |
$10K |
| D1206 |
Topical application of fluoride varnish |
626 |
579 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
84 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
27 |
12 |
$5K |
| D0274 |
Bitewings - four radiographic images |
203 |
193 |
$4K |
| D4341 |
|
45 |
16 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
29 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
69 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
256 |
234 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
71 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
21 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
69 |
$1K |
| D0330 |
Panoramic radiographic image |
49 |
45 |
$658.45 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
39 |
$348.00 |