| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2160 |
|
1,066 |
330 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,530 |
1,392 |
$28K |
| D1110 |
Prophylaxis - adult |
1,202 |
1,197 |
$23K |
| D2332 |
|
343 |
98 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
793 |
790 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
55 |
37 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
639 |
638 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
601 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,436 |
1,431 |
$11K |
| D2140 |
|
287 |
127 |
$10K |
| D9920 |
|
418 |
378 |
$7K |
| D0160 |
|
274 |
274 |
$5K |
| D2161 |
|
74 |
30 |
$4K |
| D0274 |
Bitewings - four radiographic images |
415 |
415 |
$4K |
| D9310 |
|
703 |
534 |
$4K |
| D1320 |
|
160 |
160 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
26 |
$900.00 |
| D0270 |
|
304 |
266 |
$699.00 |
| D1120 |
Prophylaxis - child |
24 |
24 |
$480.00 |