| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
767 |
762 |
$31K |
| D1110 |
Prophylaxis - adult |
573 |
570 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,060 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
380 |
378 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
598 |
585 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,449 |
1,417 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
753 |
745 |
$15K |
| D4910 |
|
173 |
172 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
48 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
20 |
14 |
$9K |
| D0274 |
Bitewings - four radiographic images |
245 |
243 |
$8K |
| D1206 |
Topical application of fluoride varnish |
282 |
278 |
$6K |
| D4342 |
|
46 |
13 |
$4K |
| D2950 |
|
30 |
26 |
$4K |