| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,063 |
3,611 |
$197K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
197 |
117 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,930 |
3,455 |
$85K |
| D1120 |
Prophylaxis - child |
1,518 |
1,267 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,486 |
1,350 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,448 |
2,785 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,268 |
1,097 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,535 |
1,229 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
369 |
352 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
535 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
166 |
84 |
$11K |
| D2950 |
|
70 |
42 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
117 |
90 |
$1K |
| D2140 |
|
15 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$816.22 |