| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,876 |
2,784 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
2,501 |
2,434 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,033 |
974 |
$38K |
| D0274 |
Bitewings - four radiographic images |
932 |
909 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
713 |
672 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
765 |
715 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
13 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
348 |
342 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
124 |
$9K |
| D0330 |
Panoramic radiographic image |
133 |
129 |
$8K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
25 |
$2K |