| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
969 |
871 |
$473K |
| D1110 |
Prophylaxis - adult |
6,203 |
6,201 |
$274K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,805 |
2,250 |
$220K |
| D2954 |
|
1,549 |
1,488 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,482 |
5,480 |
$122K |
| D0274 |
Bitewings - four radiographic images |
4,067 |
4,067 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
7,062 |
6,966 |
$76K |
| D2160 |
|
846 |
782 |
$72K |
| D3320 |
|
178 |
168 |
$39K |
| D2140 |
|
761 |
648 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,512 |
4,512 |
$32K |
| D9110 |
|
1,168 |
1,167 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,116 |
1,116 |
$25K |
| D2331 |
|
243 |
197 |
$20K |
| D0272 |
Bitewings - two radiographic images |
500 |
499 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
418 |
$5K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D2920 |
|
27 |
26 |
$804.00 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$29.78 |
| D1999 |
|
214 |
199 |
$0.00 |