| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,249 |
3,229 |
$281K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,929 |
2,919 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
2,827 |
2,810 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
2,299 |
2,290 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,928 |
3,578 |
$72K |
| D1120 |
Prophylaxis - child |
1,785 |
1,776 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,961 |
4,933 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,988 |
2,974 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
833 |
402 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
281 |
167 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
60 |
44 |
$29K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$7K |
| D2954 |
|
34 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
166 |
32 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
157 |
$2K |
| D0350 |
|
182 |
96 |
$2K |
| D9430 |
|
41 |
41 |
$1K |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$324.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |