| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,098 |
1,092 |
$96K |
| D0350 |
|
10,015 |
2,560 |
$95K |
| D4910 |
|
958 |
956 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
741 |
736 |
$49K |
| D9430 |
|
1,363 |
1,091 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
571 |
569 |
$43K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
64 |
52 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
594 |
590 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,599 |
1,593 |
$23K |
| D4341 |
|
269 |
73 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,576 |
926 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
125 |
$14K |
| D0274 |
Bitewings - four radiographic images |
579 |
576 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
65 |
$10K |
| D1320 |
|
454 |
453 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
338 |
323 |
$4K |
| D1120 |
Prophylaxis - child |
69 |
69 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$3K |
| D9910 |
|
38 |
31 |
$2K |
| D2954 |
|
14 |
12 |
$1K |