| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
971 |
965 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,211 |
1,999 |
$28K |
| D9430 |
|
790 |
762 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,079 |
1,739 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
356 |
$19K |
| D1120 |
Prophylaxis - child |
570 |
564 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
35 |
25 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
322 |
$14K |
| D0272 |
Bitewings - two radiographic images |
953 |
942 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
928 |
921 |
$9K |
| D0350 |
|
979 |
636 |
$9K |
| D1110 |
Prophylaxis - adult |
47 |
47 |
$3K |
| D9110 |
|
41 |
36 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$1K |