| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,446 |
2,431 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
3,442 |
3,429 |
$202K |
| D4910 |
|
1,163 |
1,154 |
$90K |
| D1120 |
Prophylaxis - child |
2,025 |
2,019 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,170 |
1,162 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,516 |
1,505 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,508 |
4,488 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,559 |
$52K |
| D9430 |
|
1,316 |
1,174 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,463 |
3,254 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
37 |
25 |
$18K |
| D4341 |
|
223 |
68 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
94 |
$10K |
| D0350 |
|
900 |
339 |
$8K |
| D0330 |
Panoramic radiographic image |
229 |
226 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
40 |
$4K |
| D1320 |
|
120 |
106 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
119 |
$1K |