| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,721 |
2,690 |
$144K |
| D2740 |
Crown - porcelain/ceramic |
153 |
111 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,055 |
3,039 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,253 |
1,244 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
499 |
491 |
$37K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
38 |
29 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
770 |
759 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
355 |
353 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
663 |
525 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
39 |
$4K |
| D1120 |
Prophylaxis - child |
47 |
46 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
49 |
$2K |
| D9110 |
|
37 |
37 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$568.00 |