| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
545 |
539 |
$46K |
| D9951 |
|
1,247 |
326 |
$43K |
| D4910 |
|
448 |
447 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,098 |
732 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
286 |
284 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
212 |
$14K |
| D4341 |
|
200 |
59 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
26 |
14 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
676 |
668 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
785 |
765 |
$9K |
| D9110 |
|
141 |
131 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$3K |
| D9430 |
|
51 |
46 |
$2K |