| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
745 |
739 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,654 |
1,718 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
485 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,188 |
1,185 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
356 |
354 |
$15K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
29 |
25 |
$13K |
| D4341 |
|
157 |
45 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
450 |
447 |
$6K |
| D0350 |
|
626 |
166 |
$6K |
| D1120 |
Prophylaxis - child |
130 |
129 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
79 |
$4K |
| D9430 |
|
90 |
83 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
25 |
$3K |
| D1320 |
|
156 |
156 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
153 |
$2K |