| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,934 |
1,926 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
2,257 |
2,242 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,860 |
1,854 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,773 |
3,765 |
$78K |
| D1120 |
Prophylaxis - child |
1,678 |
1,669 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,609 |
2,597 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,745 |
3,728 |
$48K |
| D9430 |
|
1,116 |
1,113 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,883 |
1,867 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
261 |
201 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
294 |
179 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |
| D2160 |
|
28 |
25 |
$2K |
| D0270 |
|
16 |
16 |
$80.00 |