| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,983 |
1,809 |
$169K |
| D1110 |
Prophylaxis - adult |
885 |
872 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,158 |
426 |
$56K |
| D2740 |
Crown - porcelain/ceramic |
77 |
50 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,047 |
1,037 |
$19K |
| D0274 |
Bitewings - four radiographic images |
955 |
947 |
$18K |
| D1120 |
Prophylaxis - child |
166 |
166 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,255 |
2,072 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,919 |
1,739 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$5K |
| D2950 |
|
39 |
30 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
109 |
$3K |
| D2332 |
|
21 |
12 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
14 |
$1K |
| D2140 |
|
21 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
345 |
343 |
$600.63 |