| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
754 |
751 |
$43K |
| D0350 |
|
4,072 |
1,105 |
$39K |
| D1110 |
Prophylaxis - adult |
431 |
430 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,571 |
1,585 |
$30K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
58 |
38 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
325 |
$20K |
| D4910 |
|
244 |
242 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
241 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
924 |
921 |
$10K |
| D0274 |
Bitewings - four radiographic images |
435 |
432 |
$9K |
| D9430 |
|
246 |
225 |
$8K |
| D1206 |
Topical application of fluoride varnish |
284 |
283 |
$5K |
| D1120 |
Prophylaxis - child |
158 |
158 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
205 |
197 |
$2K |