| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,297 |
4,171 |
$227K |
| D0120 |
Periodic oral evaluation - established patient |
3,160 |
3,072 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
1,382 |
1,313 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,375 |
1,347 |
$39K |
| D0274 |
Bitewings - four radiographic images |
942 |
910 |
$34K |
| D8670 |
Periodic orthodontic treatment visit |
156 |
140 |
$30K |
| D1120 |
Prophylaxis - child |
569 |
560 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,333 |
1,209 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
180 |
89 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
16 |
12 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
12 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
122 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
243 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
82 |
$3K |
| D4342 |
|
46 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
26 |
$3K |
| D0190 |
|
108 |
99 |
$2K |
| D1330 |
|
125 |
114 |
$2K |
| D0180 |
|
42 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$420.00 |
| D0191 |
|
17 |
17 |
$357.00 |