| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,380 |
1,357 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,363 |
1,340 |
$25K |
| D0274 |
Bitewings - four radiographic images |
854 |
835 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
198 |
109 |
$11K |
| D1206 |
Topical application of fluoride varnish |
581 |
575 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
27 |
24 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
82 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
942 |
881 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
322 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
251 |
$7K |
| D1120 |
Prophylaxis - child |
195 |
191 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
741 |
360 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
49 |
$3K |
| D2950 |
|
13 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$1K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$863.22 |