| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,819 |
1,812 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
1,036 |
1,034 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,654 |
1,646 |
$34K |
| D1120 |
Prophylaxis - child |
736 |
735 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
533 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,243 |
2,038 |
$21K |
| D4910 |
|
261 |
260 |
$20K |
| D1110 |
Prophylaxis - adult |
229 |
228 |
$19K |
| D4341 |
|
168 |
53 |
$12K |
| D0330 |
Panoramic radiographic image |
367 |
364 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
761 |
760 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
16 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
66 |
$7K |
| D0350 |
|
602 |
331 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
41 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
27 |
$2K |
| D2954 |
|
14 |
13 |
$1K |
| D9430 |
|
12 |
12 |
$384.00 |