| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,062 |
2,038 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,607 |
2,570 |
$92K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
206 |
161 |
$86K |
| D1110 |
Prophylaxis - adult |
746 |
733 |
$50K |
| D1120 |
Prophylaxis - child |
1,665 |
1,630 |
$48K |
| D0274 |
Bitewings - four radiographic images |
3,156 |
3,115 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,066 |
3,945 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
599 |
327 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,656 |
1,621 |
$28K |
| D4910 |
|
311 |
311 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,199 |
3,126 |
$17K |
| D4341 |
|
292 |
95 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
69 |
69 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
78 |
$7K |
| D9430 |
|
228 |
220 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
339 |
331 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$168.00 |