| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,300 |
1,294 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,191 |
1,188 |
$76K |
| D1110 |
Prophylaxis - adult |
597 |
597 |
$52K |
| D9430 |
|
1,576 |
1,463 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
821 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
41 |
26 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,167 |
1,136 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
742 |
736 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,250 |
746 |
$9K |
| D2952 |
|
76 |
56 |
$8K |
| D4341 |
|
93 |
27 |
$7K |
| D4910 |
|
25 |
25 |
$2K |
| D3221 |
|
13 |
12 |
$819.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$540.00 |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$536.00 |