| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,525 |
1,509 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
1,772 |
1,760 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,777 |
1,748 |
$112K |
| D1120 |
Prophylaxis - child |
1,817 |
1,793 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,137 |
1,125 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
606 |
411 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,042 |
2,017 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,801 |
1,783 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
459 |
288 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,347 |
2,494 |
$16K |
| D4341 |
|
205 |
71 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,240 |
1,219 |
$10K |
| D4910 |
|
126 |
125 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
13 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
69 |
69 |
$7K |
| D9430 |
|
316 |
259 |
$5K |
| D9110 |
|
58 |
53 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
22 |
22 |
$1K |
| D2140 |
|
25 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
74 |
71 |
$735.00 |
| D0601 |
|
72 |
71 |
$10.00 |