| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,571 |
1,555 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
948 |
939 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,044 |
1,035 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
947 |
935 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,329 |
1,317 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
499 |
463 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
12 |
$9K |
| D1206 |
Topical application of fluoride varnish |
176 |
173 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
593 |
559 |
$3K |
| D1120 |
Prophylaxis - child |
89 |
89 |
$3K |
| D0274 |
Bitewings - four radiographic images |
140 |
139 |
$2K |
| D2954 |
|
20 |
12 |
$2K |
| D0601 |
|
172 |
163 |
$1K |
| D9920 |
|
12 |
12 |
$237.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$44.85 |
| D1999 |
|
139 |
126 |
$0.00 |