| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,025 |
1,015 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
1,505 |
1,295 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
915 |
805 |
$68K |
| D2740 |
Crown - porcelain/ceramic |
57 |
24 |
$34K |
| D0330 |
Panoramic radiographic image |
218 |
214 |
$15K |
| D0274 |
Bitewings - four radiographic images |
585 |
580 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
110 |
$7K |
| D2160 |
|
105 |
50 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
31 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
461 |
215 |
$5K |
| D1206 |
Topical application of fluoride varnish |
545 |
544 |
$4K |
| D0272 |
Bitewings - two radiographic images |
347 |
342 |
$4K |
| D1120 |
Prophylaxis - child |
399 |
397 |
$4K |
| D1110 |
Prophylaxis - adult |
88 |
88 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$3K |
| D2140 |
|
27 |
13 |
$918.49 |