| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,146 |
4,958 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
5,719 |
5,533 |
$108K |
| D0274 |
Bitewings - four radiographic images |
4,244 |
4,102 |
$94K |
| D0330 |
Panoramic radiographic image |
1,351 |
1,292 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,369 |
3,269 |
$58K |
| D1120 |
Prophylaxis - child |
2,109 |
2,046 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,715 |
1,617 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
769 |
745 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
26 |
18 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,132 |
1,095 |
$13K |
| D2394 |
|
61 |
49 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
686 |
653 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$870.57 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$845.00 |