| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
477 |
477 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
446 |
445 |
$37K |
| D4910 |
|
399 |
399 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,398 |
426 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
612 |
612 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
159 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D4341 |
|
91 |
25 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
87 |
$6K |
| D0274 |
Bitewings - four radiographic images |
226 |
226 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
97 |
$1K |