| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,779 |
2,715 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,667 |
3,578 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,369 |
3,282 |
$50K |
| D2740 |
Crown - porcelain/ceramic |
201 |
107 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
848 |
499 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,834 |
1,770 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
290 |
$31K |
| D1120 |
Prophylaxis - child |
1,245 |
1,190 |
$30K |
| D2140 |
|
599 |
354 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,444 |
2,333 |
$24K |
| D2950 |
|
309 |
179 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
845 |
793 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,325 |
1,265 |
$18K |
| D0330 |
Panoramic radiographic image |
398 |
371 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,945 |
1,840 |
$15K |
| D4910 |
|
170 |
168 |
$10K |
| D2160 |
|
134 |
104 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
305 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
69 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
77 |
$5K |
| D0603 |
|
874 |
858 |
$4K |
| D0272 |
Bitewings - two radiographic images |
243 |
229 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D2332 |
|
16 |
14 |
$1K |
| D1354 |
|
96 |
52 |
$404.50 |
| D0180 |
|
14 |
14 |
$315.22 |
| D1999 |
|
1,569 |
1,376 |
$0.00 |