| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,277 |
3,586 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
3,811 |
3,044 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,847 |
1,560 |
$51K |
| D9450 |
|
2,445 |
1,758 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,494 |
2,109 |
$39K |
| D1120 |
Prophylaxis - child |
1,050 |
901 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
23 |
15 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
115 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
163 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
336 |
283 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
53 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
94 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
91 |
26 |
$2K |