| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,853 |
2,798 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
2,946 |
2,919 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,382 |
1,368 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,936 |
1,923 |
$50K |
| D1120 |
Prophylaxis - child |
950 |
947 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
57 |
32 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
1,106 |
1,052 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
14 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
652 |
589 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
25 |
13 |
$8K |
| D1351 |
Sealant - per tooth |
192 |
54 |
$8K |
| D9941 |
|
56 |
56 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$2K |