| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
740 |
738 |
$45K |
| D1110 |
Prophylaxis - adult |
551 |
551 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
605 |
604 |
$20K |
| D4341 |
|
298 |
92 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
124 |
124 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
24 |
14 |
$11K |
| D4910 |
|
173 |
173 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
512 |
512 |
$9K |
| D9430 |
|
348 |
316 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
38 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
131 |
131 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
410 |
$3K |
| D0274 |
Bitewings - four radiographic images |
129 |
129 |
$2K |
| D1320 |
|
163 |
163 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
348 |
$2K |