| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,208 |
3,190 |
$76K |
| D4910 |
|
815 |
807 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,784 |
1,777 |
$53K |
| D2740 |
Crown - porcelain/ceramic |
58 |
39 |
$49K |
| D1110 |
Prophylaxis - adult |
1,013 |
1,005 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,375 |
1,363 |
$48K |
| D0330 |
Panoramic radiographic image |
892 |
889 |
$46K |
| D4346 |
|
965 |
965 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
287 |
183 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
181 |
$33K |
| D1206 |
Topical application of fluoride varnish |
901 |
891 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,350 |
1,341 |
$17K |
| D1120 |
Prophylaxis - child |
111 |
108 |
$4K |
| D0180 |
|
67 |
67 |
$3K |
| D0380 |
|
14 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$965.09 |