| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,457 |
2,274 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,527 |
2,341 |
$65K |
| D2740 |
Crown - porcelain/ceramic |
86 |
67 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,144 |
1,073 |
$36K |
| D1206 |
Topical application of fluoride varnish |
995 |
900 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
463 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
792 |
720 |
$11K |
| D2950 |
|
81 |
64 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
64 |
$6K |
| D1120 |
Prophylaxis - child |
94 |
91 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$1K |