| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,199 |
1,184 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,609 |
1,231 |
$27K |
| D4341 |
|
312 |
94 |
$19K |
| D4910 |
|
200 |
200 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
256 |
$15K |
| D9430 |
|
400 |
393 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
204 |
199 |
$9K |
| D0272 |
Bitewings - two radiographic images |
657 |
645 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
144 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
404 |
392 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
324 |
324 |
$5K |
| D9110 |
|
76 |
69 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
25 |
$3K |
| D2931 |
|
15 |
12 |
$2K |