| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,733 |
1,728 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
1,507 |
1,496 |
$107K |
| D1120 |
Prophylaxis - child |
1,791 |
1,779 |
$77K |
| D1110 |
Prophylaxis - adult |
801 |
798 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,080 |
2,455 |
$49K |
| D4910 |
|
631 |
627 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
948 |
944 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,692 |
2,678 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
357 |
148 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,836 |
1,827 |
$22K |
| D4341 |
|
250 |
67 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
12 |
$9K |
| D9430 |
|
260 |
234 |
$8K |
| D1320 |
|
609 |
608 |
$8K |
| D0330 |
Panoramic radiographic image |
133 |
133 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
107 |
107 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
83 |
$996.00 |
| D1330 |
|
18 |
18 |
$0.00 |
| D1310 |
|
18 |
18 |
$0.00 |