| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,272 |
2,159 |
$109K |
| D1110 |
Prophylaxis - adult |
1,301 |
1,280 |
$58K |
| D9920 |
|
3,040 |
1,730 |
$57K |
| D4355 |
|
550 |
516 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
930 |
898 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
69 |
52 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,632 |
1,578 |
$34K |
| D1206 |
Topical application of fluoride varnish |
699 |
690 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
636 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,372 |
2,069 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
417 |
412 |
$11K |
| D1120 |
Prophylaxis - child |
230 |
228 |
$10K |
| D0274 |
Bitewings - four radiographic images |
662 |
655 |
$9K |
| D0191 |
|
413 |
296 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,653 |
1,300 |
$5K |
| D1320 |
|
159 |
159 |
$2K |
| D2954 |
|
16 |
13 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
13 |
$675.72 |
| D0180 |
|
17 |
17 |
$467.82 |
| D0272 |
Bitewings - two radiographic images |
27 |
25 |
$247.50 |
| D9110 |
|
27 |
24 |
$194.50 |
| D9911 |
|
91 |
26 |
$182.00 |
| D1354 |
|
204 |
22 |
$52.50 |
| D0601 |
|
12 |
12 |
$42.00 |