| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
979 |
977 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
731 |
729 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
490 |
$31K |
| D1120 |
Prophylaxis - child |
674 |
673 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,471 |
975 |
$22K |
| D1110 |
Prophylaxis - adult |
212 |
211 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,407 |
1,405 |
$17K |
| D0274 |
Bitewings - four radiographic images |
389 |
387 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |