| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,347 |
1,337 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,232 |
1,227 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
980 |
967 |
$74K |
| D4910 |
|
914 |
907 |
$69K |
| D4341 |
|
620 |
211 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
660 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,097 |
1,458 |
$30K |
| D1120 |
Prophylaxis - child |
585 |
580 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,831 |
1,814 |
$25K |
| D1320 |
|
852 |
843 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
14 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
778 |
771 |
$9K |
| D0274 |
Bitewings - four radiographic images |
358 |
357 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
69 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
51 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
39 |
$4K |
| D9110 |
|
66 |
66 |
$4K |
| D0272 |
Bitewings - two radiographic images |
257 |
245 |
$3K |
| D1999 |
|
13 |
13 |
$0.00 |