| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,421 |
1,414 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,217 |
1,215 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
967 |
958 |
$74K |
| D4910 |
|
667 |
661 |
$51K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
91 |
72 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
831 |
830 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,001 |
1,944 |
$33K |
| D4341 |
|
417 |
115 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
361 |
231 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
387 |
200 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,228 |
1,218 |
$17K |
| D0274 |
Bitewings - four radiographic images |
612 |
612 |
$13K |
| D0350 |
|
1,321 |
621 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
928 |
834 |
$11K |
| D1120 |
Prophylaxis - child |
198 |
198 |
$9K |
| D9430 |
|
255 |
246 |
$8K |
| D2954 |
|
43 |
37 |
$5K |
| D0272 |
Bitewings - two radiographic images |
397 |
397 |
$4K |
| D1206 |
Topical application of fluoride varnish |
261 |
261 |
$4K |