| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,136 |
$44K |
| D1110 |
Prophylaxis - adult |
996 |
990 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
263 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
836 |
834 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
34 |
26 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
48 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
282 |
278 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
462 |
454 |
$6K |
| D0274 |
Bitewings - four radiographic images |
130 |
130 |
$4K |
| D2950 |
|
15 |
14 |
$2K |