| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,397 |
2,335 |
$124K |
| D0274 |
Bitewings - four radiographic images |
1,540 |
1,499 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,828 |
1,786 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
764 |
738 |
$32K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
44 |
25 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
242 |
237 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
307 |
305 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
203 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
40 |
$7K |
| D1120 |
Prophylaxis - child |
62 |
62 |
$3K |
| D0330 |
Panoramic radiographic image |
50 |
48 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
154 |
149 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
12 |
$2K |
| D9410 |
|
35 |
13 |
$36.00 |