| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,941 |
1,926 |
$166K |
| D0120 |
Periodic oral evaluation - established patient |
1,754 |
1,747 |
$102K |
| D4341 |
|
1,215 |
331 |
$85K |
| D9920 |
|
638 |
619 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,852 |
3,237 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
1,001 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,466 |
2,444 |
$51K |
| D0330 |
Panoramic radiographic image |
1,342 |
1,339 |
$40K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
47 |
29 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
231 |
108 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
721 |
720 |
$10K |
| D1120 |
Prophylaxis - child |
144 |
142 |
$5K |
| D2332 |
|
46 |
12 |
$4K |
| D2330 |
|
43 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
66 |
$715.00 |
| D0270 |
|
12 |
12 |
$60.00 |