| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
1,991 |
1,974 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
2,572 |
2,555 |
$124K |
| D4341 |
|
1,725 |
494 |
$119K |
| D1110 |
Prophylaxis - adult |
1,499 |
1,490 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,758 |
4,010 |
$78K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
163 |
115 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
920 |
912 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,533 |
2,515 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,320 |
3,297 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
760 |
755 |
$36K |
| D1120 |
Prophylaxis - child |
987 |
981 |
$34K |
| D9430 |
|
939 |
920 |
$30K |
| D2954 |
|
154 |
118 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
61 |
$7K |
| D1351 |
Sealant - per tooth |
180 |
37 |
$5K |
| D9993 |
|
26 |
26 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
31 |
$1K |
| D1310 |
|
26 |
26 |
$1K |
| D9110 |
|
12 |
12 |
$756.00 |
| D0601 |
|
19 |
19 |
$240.00 |