| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,294 |
1,283 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,188 |
2,327 |
$60K |
| D1110 |
Prophylaxis - adult |
590 |
580 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,939 |
2,644 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,002 |
1,990 |
$25K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
51 |
38 |
$24K |
| D1120 |
Prophylaxis - child |
711 |
708 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
316 |
$19K |
| D0350 |
|
2,446 |
1,168 |
$11K |
| D9430 |
|
210 |
184 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
36 |
$4K |
| D2952 |
|
17 |
13 |
$2K |
| D7510 |
|
13 |
13 |
$910.00 |