| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,261 |
4,232 |
$239K |
| D1110 |
Prophylaxis - adult |
2,267 |
2,246 |
$194K |
| D9110 |
|
2,380 |
2,322 |
$149K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,405 |
5,647 |
$136K |
| D4341 |
|
1,994 |
552 |
$134K |
| D1120 |
Prophylaxis - child |
2,865 |
2,846 |
$112K |
| D4910 |
|
1,396 |
1,388 |
$110K |
| D1206 |
Topical application of fluoride varnish |
5,454 |
5,415 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,191 |
$76K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
145 |
71 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,035 |
1,027 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,368 |
3,315 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
482 |
199 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,331 |
2,319 |
$27K |
| D1351 |
Sealant - per tooth |
705 |
197 |
$20K |
| D2954 |
|
156 |
65 |
$16K |
| D1310 |
|
252 |
252 |
$11K |
| D0350 |
|
914 |
367 |
$10K |
| D9993 |
|
136 |
136 |
$9K |
| D7510 |
|
98 |
98 |
$7K |
| D7111 |
|
80 |
53 |
$5K |
| D2140 |
|
66 |
29 |
$4K |
| D2330 |
|
24 |
13 |
$2K |
| D0603 |
|
43 |
43 |
$630.00 |
| D0601 |
|
13 |
13 |
$195.00 |