| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,121 |
3,868 |
$203K |
| D0120 |
Periodic oral evaluation - established patient |
3,896 |
3,675 |
$85K |
| D0274 |
Bitewings - four radiographic images |
1,389 |
1,306 |
$45K |
| D2740 |
Crown - porcelain/ceramic |
56 |
38 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
542 |
336 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,087 |
1,922 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,249 |
1,177 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
402 |
378 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
478 |
248 |
$26K |
| D1120 |
Prophylaxis - child |
438 |
418 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,662 |
1,423 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
456 |
425 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
69 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
16 |
$1K |
| D0180 |
|
14 |
14 |
$518.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$402.00 |
| D1999 |
|
129 |
111 |
$0.00 |