| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,566 |
2,556 |
$135K |
| D1110 |
Prophylaxis - adult |
1,584 |
1,581 |
$135K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
246 |
167 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,673 |
1,667 |
$105K |
| D1120 |
Prophylaxis - child |
1,621 |
1,621 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,141 |
1,137 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,792 |
3,780 |
$47K |
| D4341 |
|
503 |
140 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,835 |
2,390 |
$28K |
| D9430 |
|
785 |
736 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,127 |
1,125 |
$24K |
| D4910 |
|
230 |
230 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,339 |
1,281 |
$16K |
| D1351 |
Sealant - per tooth |
528 |
106 |
$11K |
| D9110 |
|
167 |
155 |
$10K |
| D2335 |
|
52 |
25 |
$6K |
| D2954 |
|
52 |
38 |
$5K |
| D1320 |
|
246 |
246 |
$4K |
| D0350 |
|
649 |
222 |
$3K |
| D2160 |
|
30 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
112 |
112 |
$1K |