| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,947 |
2,913 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
3,236 |
3,198 |
$92K |
| D1206 |
Topical application of fluoride varnish |
2,101 |
2,078 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,162 |
1,119 |
$58K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
74 |
50 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
516 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,942 |
3,574 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,875 |
2,764 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,273 |
1,256 |
$18K |
| D1120 |
Prophylaxis - child |
312 |
312 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
100 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
66 |
66 |
$759.00 |
| D0603 |
|
12 |
12 |
$120.00 |