| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,110 |
1,106 |
$55K |
| D1120 |
Prophylaxis - child |
1,132 |
1,121 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
719 |
$46K |
| D1110 |
Prophylaxis - adult |
406 |
404 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
46 |
28 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,470 |
1,909 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
335 |
333 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,231 |
1,225 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
620 |
618 |
$8K |
| D0274 |
Bitewings - four radiographic images |
196 |
195 |
$4K |
| D2954 |
|
13 |
12 |
$1K |