| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,564 |
4,468 |
$241K |
| D6010 |
|
146 |
67 |
$157K |
| D4266 |
|
446 |
98 |
$128K |
| D0274 |
Bitewings - four radiographic images |
3,176 |
3,137 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,789 |
4,697 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,140 |
1,117 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
5,205 |
5,009 |
$81K |
| D4264 |
|
312 |
86 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,849 |
3,642 |
$54K |
| D4260 |
|
73 |
68 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,792 |
1,778 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
435 |
$52K |
| D1120 |
Prophylaxis - child |
917 |
909 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
1,046 |
$46K |
| D4263 |
|
131 |
113 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
196 |
$22K |
| D4381 |
|
227 |
27 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
26 |
14 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
198 |
$8K |
| D4341 |
|
86 |
25 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0180 |
|
13 |
13 |
$390.00 |
| D1330 |
|
90 |
89 |
$168.00 |