| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,248 |
1,245 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,515 |
1,506 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
848 |
837 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
493 |
482 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
14 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,197 |
1,138 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
155 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
378 |
367 |
$3K |
| D2950 |
|
32 |
32 |
$2K |
| D0274 |
Bitewings - four radiographic images |
152 |
151 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
79 |
$1K |
| D2140 |
|
30 |
26 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
14 |
$913.00 |
| D9110 |
|
30 |
30 |
$639.03 |
| D1120 |
Prophylaxis - child |
21 |
21 |
$489.04 |
| D0603 |
|
29 |
29 |
$290.00 |
| D0602 |
|
14 |
14 |
$140.00 |