| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,436 |
1,423 |
$82K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
121 |
100 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
862 |
858 |
$54K |
| D1110 |
Prophylaxis - adult |
570 |
561 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,402 |
1,975 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
300 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,302 |
1,292 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
556 |
$26K |
| D1120 |
Prophylaxis - child |
691 |
688 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,832 |
1,818 |
$22K |
| D4910 |
|
287 |
287 |
$22K |
| D2954 |
|
110 |
91 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
107 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D2952 |
|
12 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$928.20 |
| D9430 |
|
14 |
12 |
$448.00 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$274.00 |