| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,559 |
1,487 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
528 |
288 |
$63K |
| D1320 |
|
1,071 |
1,008 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
959 |
866 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,365 |
1,307 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,316 |
1,240 |
$25K |
| D0274 |
Bitewings - four radiographic images |
747 |
712 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
473 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
41 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
12 |
12 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
296 |
$5K |
| D0330 |
Panoramic radiographic image |
101 |
93 |
$5K |
| D0367 |
|
13 |
13 |
$4K |
| D2950 |
|
28 |
28 |
$3K |
| D3120 |
|
81 |
49 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
29 |
$2K |
| D4910 |
|
41 |
40 |
$2K |
| D4355 |
|
12 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
28 |
26 |
$651.42 |