| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,507 |
3,421 |
$179K |
| D2740 |
Crown - porcelain/ceramic |
148 |
81 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,090 |
2,038 |
$48K |
| D1120 |
Prophylaxis - child |
764 |
748 |
$38K |
| D0274 |
Bitewings - four radiographic images |
987 |
960 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,094 |
1,066 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
505 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
25 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
246 |
244 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
144 |
$16K |
| D2950 |
|
69 |
40 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
652 |
620 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
225 |
$9K |
| D2954 |
|
21 |
14 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
30 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
37 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
27 |
$657.00 |