| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,639 |
3,633 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
3,036 |
3,030 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,914 |
1,909 |
$120K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
206 |
181 |
$97K |
| D4341 |
|
1,338 |
379 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,689 |
1,685 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,676 |
3,351 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,101 |
620 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,493 |
4,483 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,621 |
2,617 |
$55K |
| D9430 |
|
851 |
833 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
394 |
287 |
$26K |
| D1120 |
Prophylaxis - child |
621 |
621 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,669 |
1,646 |
$20K |
| D2954 |
|
151 |
137 |
$16K |
| D2140 |
|
268 |
156 |
$14K |
| D0350 |
|
1,339 |
760 |
$13K |
| D3320 |
|
12 |
12 |
$4K |
| D2330 |
|
17 |
12 |
$1K |
| D4910 |
|
12 |
12 |
$660.00 |