| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,509 |
1,490 |
$123K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
254 |
164 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
1,797 |
1,770 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,009 |
994 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,841 |
2,101 |
$40K |
| D1120 |
Prophylaxis - child |
794 |
781 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,085 |
2,050 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
318 |
318 |
$15K |
| D0330 |
Panoramic radiographic image |
313 |
306 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
114 |
42 |
$8K |
| D1206 |
Topical application of fluoride varnish |
588 |
580 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
26 |
$5K |
| D9430 |
|
134 |
124 |
$4K |
| D4341 |
|
34 |
14 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
40 |
$513.00 |
| D1999 |
|
160 |
159 |
$46.00 |