| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,745 |
2,738 |
$144K |
| D1120 |
Prophylaxis - child |
2,246 |
2,236 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,738 |
3,214 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
500 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,571 |
2,561 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,522 |
2,514 |
$29K |
| D7111 |
|
294 |
202 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
16 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
83 |
63 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
112 |
$5K |
| D2140 |
|
94 |
54 |
$5K |
| D2954 |
|
16 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
84 |
$972.00 |
| D0350 |
|
75 |
72 |
$662.40 |