| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,979 |
2,968 |
$181K |
| D1110 |
Prophylaxis - adult |
1,925 |
1,919 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
2,102 |
$117K |
| D1120 |
Prophylaxis - child |
2,064 |
2,055 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
2,198 |
2,190 |
$88K |
| D2740 |
Crown - porcelain/ceramic |
171 |
139 |
$79K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
132 |
121 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,660 |
2,650 |
$44K |
| D9430 |
|
1,400 |
1,284 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,243 |
1,239 |
$35K |
| D9999 |
Unspecified adjunctive procedure, by report |
252 |
248 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,284 |
1,279 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,477 |
3,212 |
$16K |
| D2954 |
|
148 |
122 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,616 |
1,588 |
$9K |
| D3348 |
|
12 |
12 |
$6K |
| D0270 |
|
830 |
826 |
$3K |
| D0272 |
Bitewings - two radiographic images |
378 |
378 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$758.00 |
| D4910 |
|
12 |
12 |
$724.00 |
| D1310 |
|
29 |
29 |
$0.00 |