| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,648 |
2,636 |
$154K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
263 |
168 |
$125K |
| D1120 |
Prophylaxis - child |
2,993 |
2,976 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,478 |
1,470 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,123 |
3,339 |
$92K |
| D1110 |
Prophylaxis - adult |
666 |
661 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
828 |
416 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
856 |
853 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,041 |
3,021 |
$39K |
| D4341 |
|
553 |
154 |
$39K |
| D1351 |
Sealant - per tooth |
867 |
238 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,139 |
2,127 |
$25K |
| D2140 |
|
421 |
189 |
$22K |
| D2954 |
|
119 |
86 |
$13K |
| D1206 |
Topical application of fluoride varnish |
665 |
661 |
$12K |
| D4910 |
|
61 |
61 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
350 |
$4K |
| D9430 |
|
80 |
69 |
$3K |
| D7111 |
|
44 |
27 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$2K |
| D0350 |
|
145 |
69 |
$1K |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$324.00 |