| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,281 |
1,280 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
1,940 |
1,934 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,732 |
2,868 |
$51K |
| D4910 |
|
433 |
431 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
65 |
41 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,473 |
2,406 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,873 |
1,867 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
244 |
$15K |
| D1120 |
Prophylaxis - child |
439 |
437 |
$15K |
| D9430 |
|
282 |
256 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
55 |
$6K |
| D0272 |
Bitewings - two radiographic images |
268 |
265 |
$3K |
| D4341 |
|
42 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
27 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
16 |
$1K |
| D2330 |
|
21 |
13 |
$1K |
| D0350 |
|
111 |
84 |
$1K |