| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
2,765 |
$165K |
| D1110 |
Prophylaxis - adult |
1,883 |
1,878 |
$164K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
320 |
248 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,098 |
4,034 |
$80K |
| D1120 |
Prophylaxis - child |
1,631 |
1,628 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
792 |
790 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
551 |
$35K |
| D9430 |
|
1,095 |
1,043 |
$35K |
| D0350 |
|
3,436 |
1,291 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,472 |
2,465 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,148 |
2,145 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
272 |
173 |
$16K |
| D1206 |
Topical application of fluoride varnish |
934 |
933 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,189 |
1,112 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
169 |
92 |
$9K |
| D4910 |
|
109 |
109 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
56 |
$6K |
| D2140 |
|
91 |
54 |
$5K |
| D2954 |
|
31 |
27 |
$3K |
| D0274 |
Bitewings - four radiographic images |
106 |
106 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$1K |