| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,009 |
2,788 |
$143K |
| D2740 |
Crown - porcelain/ceramic |
130 |
85 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
913 |
500 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,071 |
476 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,586 |
2,416 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,309 |
$46K |
| D0330 |
Panoramic radiographic image |
499 |
473 |
$32K |
| D2954 |
|
124 |
88 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
514 |
483 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
14 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
340 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
491 |
467 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
176 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
490 |
$7K |
| D1120 |
Prophylaxis - child |
74 |
69 |
$3K |
| D9110 |
|
77 |
67 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
49 |
$681.00 |