| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,276 |
2,191 |
$115K |
| D2740 |
Crown - porcelain/ceramic |
116 |
62 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,114 |
1,917 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,363 |
1,314 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
224 |
$24K |
| D2950 |
|
176 |
106 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,698 |
1,587 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,286 |
853 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
205 |
122 |
$13K |
| D9110 |
|
330 |
302 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
283 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
295 |
289 |
$8K |
| D0330 |
Panoramic radiographic image |
188 |
177 |
$8K |
| D1120 |
Prophylaxis - child |
143 |
143 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
194 |
178 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
83 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
60 |
$6K |
| D1206 |
Topical application of fluoride varnish |
90 |
87 |
$2K |
| D2394 |
|
19 |
15 |
$2K |
| D9910 |
|
26 |
15 |
$0.00 |
| D0350 |
|
58 |
54 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
44 |
39 |
$0.00 |