| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,215 |
3,006 |
$156K |
| D2740 |
Crown - porcelain/ceramic |
114 |
65 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
797 |
460 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,595 |
1,488 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,387 |
2,271 |
$52K |
| D2950 |
|
331 |
209 |
$50K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
68 |
46 |
$38K |
| D2394 |
|
185 |
106 |
$20K |
| D0274 |
Bitewings - four radiographic images |
615 |
552 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,324 |
1,219 |
$18K |
| D0272 |
Bitewings - two radiographic images |
736 |
718 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
211 |
204 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
489 |
470 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
310 |
$12K |
| D1120 |
Prophylaxis - child |
227 |
215 |
$10K |
| D4346 |
|
192 |
173 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
51 |
$6K |
| D2335 |
|
29 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$830.00 |