| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,838 |
5,664 |
$302K |
| D2740 |
Crown - porcelain/ceramic |
275 |
204 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
5,368 |
5,205 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,118 |
692 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,262 |
2,191 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
364 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,049 |
1,928 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
882 |
853 |
$25K |
| D1120 |
Prophylaxis - child |
384 |
372 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
422 |
412 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
240 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
24 |
16 |
$14K |
| D0330 |
Panoramic radiographic image |
171 |
166 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
237 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
754 |
659 |
$9K |
| D9110 |
|
193 |
177 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |