| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,783 |
5,563 |
$301K |
| D2740 |
Crown - porcelain/ceramic |
436 |
247 |
$293K |
| D0274 |
Bitewings - four radiographic images |
3,974 |
3,815 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
5,641 |
5,466 |
$128K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
167 |
86 |
$87K |
| D0330 |
Panoramic radiographic image |
1,778 |
1,685 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,245 |
2,192 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,133 |
501 |
$62K |
| D1120 |
Prophylaxis - child |
1,070 |
1,046 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
673 |
396 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,253 |
1,170 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
1,901 |
1,601 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
407 |
383 |
$15K |
| D1351 |
Sealant - per tooth |
291 |
83 |
$10K |
| D2954 |
|
36 |
29 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
50 |
$5K |
| D2950 |
|
22 |
15 |
$3K |
| D3120 |
|
68 |
40 |
$2K |
| D1999 |
|
15 |
12 |
$0.00 |
| D1330 |
|
26 |
26 |
$0.00 |