| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,293 |
1,188 |
$66K |
| D2740 |
Crown - porcelain/ceramic |
62 |
38 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
316 |
144 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
279 |
271 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
811 |
752 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
370 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
413 |
377 |
$15K |
| D0274 |
Bitewings - four radiographic images |
358 |
352 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
386 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
475 |
$7K |
| D1120 |
Prophylaxis - child |
142 |
139 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
98 |
$1K |