| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,220 |
2,134 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,848 |
2,980 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,147 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,743 |
3,646 |
$44K |
| D1120 |
Prophylaxis - child |
1,160 |
1,155 |
$41K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
85 |
67 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
549 |
339 |
$36K |
| D1110 |
Prophylaxis - adult |
401 |
399 |
$36K |
| D2160 |
|
350 |
234 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
171 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
81 |
$648.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |
| D1330 |
|
24 |
23 |
$0.00 |