| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,705 |
3,643 |
$202K |
| D2740 |
Crown - porcelain/ceramic |
190 |
96 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,938 |
3,893 |
$98K |
| D0274 |
Bitewings - four radiographic images |
1,668 |
1,636 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
228 |
$54K |
| D1120 |
Prophylaxis - child |
903 |
899 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,575 |
1,569 |
$46K |
| D2950 |
|
193 |
131 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
666 |
652 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,316 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
382 |
367 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
598 |
536 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$802.00 |
| D0270 |
|
57 |
56 |
$712.00 |
| D1999 |
|
72 |
65 |
$0.00 |