| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,805 |
3,787 |
$190K |
| D1120 |
Prophylaxis - child |
3,153 |
3,131 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,618 |
1,609 |
$100K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
196 |
160 |
$92K |
| D1110 |
Prophylaxis - adult |
1,080 |
1,072 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,232 |
3,211 |
$67K |
| D9430 |
|
1,971 |
1,891 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
857 |
477 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,642 |
5,090 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,099 |
3,080 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,502 |
2,363 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
407 |
406 |
$19K |
| D2954 |
|
174 |
145 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
49 |
$11K |
| D0272 |
Bitewings - two radiographic images |
776 |
773 |
$9K |
| D2160 |
|
17 |
13 |
$1K |