| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,196 |
5,063 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
4,765 |
4,686 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
2,279 |
2,211 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,360 |
2,315 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
4,917 |
4,730 |
$72K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
128 |
72 |
$68K |
| D1120 |
Prophylaxis - child |
1,155 |
1,139 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
701 |
507 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,616 |
1,592 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,752 |
2,730 |
$45K |
| D0330 |
Panoramic radiographic image |
543 |
531 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
824 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
37 |
28 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
210 |
$15K |
| D2950 |
|
73 |
54 |
$9K |
| D2140 |
|
63 |
51 |
$4K |
| D4341 |
|
26 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$2K |
| D2160 |
|
18 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$384.00 |