| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
784 |
774 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
999 |
993 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
532 |
528 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
743 |
737 |
$36K |
| D4341 |
|
469 |
119 |
$33K |
| D1120 |
Prophylaxis - child |
415 |
414 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,113 |
1,106 |
$18K |
| D9430 |
|
538 |
521 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,368 |
961 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
776 |
755 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
14 |
$9K |
| D0274 |
Bitewings - four radiographic images |
297 |
295 |
$6K |
| D4910 |
|
80 |
80 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
27 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
140 |
139 |
$2K |
| D0272 |
Bitewings - two radiographic images |
107 |
98 |
$1K |
| D0350 |
|
60 |
25 |
$641.40 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |
| D1999 |
|
12 |
12 |
$10.00 |