| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
998 |
992 |
$73K |
| D4910 |
|
839 |
836 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
117 |
76 |
$56K |
| D1110 |
Prophylaxis - adult |
560 |
552 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
695 |
687 |
$45K |
| D4341 |
|
395 |
118 |
$28K |
| D1120 |
Prophylaxis - child |
610 |
609 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
537 |
529 |
$26K |
| D0350 |
|
2,588 |
891 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,741 |
1,553 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,512 |
1,502 |
$21K |
| D9430 |
|
374 |
348 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
78 |
$10K |
| D0274 |
Bitewings - four radiographic images |
399 |
396 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
682 |
643 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
57 |
57 |
$2K |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$590.00 |