| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,166 |
3,029 |
$153K |
| D0274 |
Bitewings - four radiographic images |
1,583 |
1,513 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,653 |
1,580 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
36 |
26 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
458 |
438 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
169 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
398 |
383 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
258 |
$9K |
| D1120 |
Prophylaxis - child |
164 |
159 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
54 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
67 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
429 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$6K |
| D0330 |
Panoramic radiographic image |
105 |
104 |
$6K |
| D2394 |
|
21 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
29 |
$1K |