| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,029 |
3,022 |
$193K |
| D1110 |
Prophylaxis - adult |
2,068 |
2,065 |
$176K |
| D0210 |
Intraoral - complete series of radiographic images |
2,964 |
2,958 |
$139K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
276 |
216 |
$130K |
| D2740 |
Crown - porcelain/ceramic |
256 |
171 |
$112K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
139 |
121 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
993 |
985 |
$52K |
| D2954 |
|
479 |
348 |
$50K |
| D9430 |
|
1,286 |
1,243 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,929 |
2,921 |
$39K |
| D1120 |
Prophylaxis - child |
912 |
907 |
$31K |
| D3320 |
|
70 |
62 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,343 |
1,721 |
$17K |
| D4341 |
|
227 |
61 |
$16K |
| D0274 |
Bitewings - four radiographic images |
598 |
597 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
627 |
622 |
$7K |
| D3310 |
|
20 |
14 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
38 |
$3K |
| D1206 |
Topical application of fluoride varnish |
233 |
231 |
$2K |
| D0350 |
|
122 |
67 |
$1K |
| D2140 |
|
19 |
13 |
$1K |
| D4910 |
|
12 |
12 |
$924.00 |