| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
4,385 |
3,547 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
1,786 |
1,768 |
$99K |
| D2740 |
Crown - porcelain/ceramic |
187 |
115 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,320 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,336 |
1,330 |
$62K |
| D1110 |
Prophylaxis - adult |
650 |
649 |
$57K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
106 |
69 |
$50K |
| D1120 |
Prophylaxis - child |
889 |
883 |
$35K |
| D4910 |
|
395 |
392 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,264 |
2,170 |
$25K |
| D2954 |
|
241 |
170 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,058 |
1,053 |
$22K |
| D1206 |
Topical application of fluoride varnish |
950 |
944 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
121 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
57 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
625 |
575 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
64 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
447 |
445 |
$5K |
| D4341 |
|
43 |
12 |
$3K |