| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,864 |
1,852 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
1,313 |
1,305 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
902 |
900 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,050 |
1,914 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
67 |
50 |
$32K |
| D0274 |
Bitewings - four radiographic images |
832 |
831 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,044 |
1,013 |
$12K |
| D9430 |
|
314 |
309 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
548 |
545 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$418.00 |