| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,607 |
3,536 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,247 |
2,141 |
$57K |
| D1110 |
Prophylaxis - adult |
1,469 |
1,434 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,984 |
3,792 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,018 |
1,966 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,793 |
1,893 |
$32K |
| D2954 |
|
161 |
135 |
$18K |
| D5110 |
|
13 |
13 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$5K |
| D1120 |
Prophylaxis - child |
90 |
89 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
49 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
77 |
77 |
$2K |
| D2140 |
|
22 |
14 |
$1K |
| D5612 |
|
12 |
12 |
$858.00 |
| D0270 |
|
98 |
95 |
$549.92 |