| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,876 |
4,654 |
$248K |
| D2740 |
Crown - porcelain/ceramic |
336 |
229 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
3,302 |
3,129 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,496 |
1,435 |
$51K |
| D1120 |
Prophylaxis - child |
922 |
900 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,402 |
1,370 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
470 |
$35K |
| D2954 |
|
152 |
111 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
668 |
625 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
514 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,484 |
1,211 |
$21K |
| D0330 |
Panoramic radiographic image |
202 |
198 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
105 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
39 |
$6K |
| D2950 |
|
35 |
25 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
433 |
297 |
$4K |