| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,125 |
3,057 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,010 |
611 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,096 |
2,055 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,006 |
2,957 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
392 |
385 |
$28K |
| D8670 |
Periodic orthodontic treatment visit |
101 |
98 |
$28K |
| D2740 |
Crown - porcelain/ceramic |
39 |
28 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
446 |
281 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
791 |
780 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
459 |
441 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
390 |
369 |
$14K |
| D1120 |
Prophylaxis - child |
275 |
270 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
598 |
$9K |
| D0330 |
Panoramic radiographic image |
155 |
141 |
$7K |
| D9310 |
|
12 |
12 |
$567.00 |
| D8660 |
|
29 |
26 |
$434.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
13 |
$212.00 |
| D1999 |
|
207 |
178 |
$0.00 |