| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,929 |
2,921 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,397 |
$155K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
306 |
198 |
$146K |
| D1120 |
Prophylaxis - child |
2,650 |
2,643 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,838 |
1,831 |
$87K |
| D1110 |
Prophylaxis - adult |
790 |
788 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,292 |
2,286 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,708 |
3,698 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
384 |
202 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,318 |
3,411 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
79 |
70 |
$37K |
| D9430 |
|
1,077 |
913 |
$34K |
| D2954 |
|
207 |
139 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
289 |
139 |
$19K |
| D4910 |
|
107 |
106 |
$8K |
| D1351 |
Sealant - per tooth |
197 |
40 |
$4K |
| D2160 |
|
47 |
31 |
$4K |
| D0272 |
Bitewings - two radiographic images |
149 |
149 |
$2K |