| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
941 |
898 |
$50K |
| D2740 |
Crown - porcelain/ceramic |
61 |
38 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
838 |
803 |
$19K |
| D0274 |
Bitewings - four radiographic images |
387 |
374 |
$14K |
| D2950 |
|
48 |
28 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
348 |
$6K |
| D1206 |
Topical application of fluoride varnish |
232 |
225 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
100 |
$4K |
| D0180 |
|
102 |
97 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
40 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$605.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
12 |
$203.00 |