| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,551 |
1,542 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,720 |
1,715 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
1,658 |
1,652 |
$91K |
| D1120 |
Prophylaxis - child |
1,195 |
1,191 |
$44K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
89 |
71 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
932 |
927 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,522 |
1,515 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,614 |
1,607 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,391 |
2,125 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
167 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,149 |
1,146 |
$17K |
| D9430 |
|
459 |
437 |
$14K |
| D1320 |
|
1,039 |
1,037 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
112 |
83 |
$13K |
| D0350 |
|
1,334 |
582 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
66 |
$7K |
| D4910 |
|
78 |
78 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
52 |
51 |
$5K |
| D2952 |
|
47 |
33 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
518 |
$4K |
| D1999 |
|
274 |
229 |
$240.00 |