| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,093 |
1,090 |
$72K |
| D4910 |
|
937 |
933 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
666 |
666 |
$54K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
86 |
78 |
$41K |
| D1110 |
Prophylaxis - adult |
454 |
454 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,162 |
1,677 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,315 |
1,313 |
$28K |
| D1120 |
Prophylaxis - child |
607 |
607 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,656 |
1,652 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
303 |
$14K |
| D4341 |
|
161 |
46 |
$11K |
| D9430 |
|
316 |
307 |
$10K |
| D1351 |
Sealant - per tooth |
162 |
39 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
50 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
71 |
52 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
377 |
$5K |
| D2954 |
|
24 |
24 |
$3K |
| D2140 |
|
35 |
25 |
$2K |
| D0350 |
|
165 |
112 |
$2K |