| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
893 |
841 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
969 |
960 |
$55K |
| D1110 |
Prophylaxis - adult |
546 |
539 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,207 |
1,852 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,467 |
1,456 |
$20K |
| D4910 |
|
122 |
121 |
$9K |
| D0272 |
Bitewings - two radiographic images |
747 |
741 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
125 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$6K |
| D4341 |
|
83 |
26 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
349 |
341 |
$4K |
| D1120 |
Prophylaxis - child |
109 |
109 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
27 |
$3K |
| D9951 |
|
64 |
54 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
58 |
$2K |
| D2940 |
|
20 |
18 |
$1K |
| D0350 |
|
34 |
24 |
$240.00 |