| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,223 |
1,129 |
$58K |
| D2740 |
Crown - porcelain/ceramic |
60 |
48 |
$37K |
| D0274 |
Bitewings - four radiographic images |
839 |
802 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,173 |
1,108 |
$28K |
| D1120 |
Prophylaxis - child |
523 |
486 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
132 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
516 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
759 |
721 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
176 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
92 |
82 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
93 |
53 |
$4K |
| D2950 |
|
15 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
104 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D0270 |
|
16 |
14 |
$98.00 |