| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,440 |
2,422 |
$155K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,225 |
581 |
$143K |
| D0210 |
Intraoral - complete series of radiographic images |
2,116 |
2,103 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
1,762 |
1,745 |
$95K |
| D2740 |
Crown - porcelain/ceramic |
133 |
93 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,024 |
2,467 |
$53K |
| D1120 |
Prophylaxis - child |
1,360 |
1,344 |
$53K |
| D1110 |
Prophylaxis - adult |
423 |
423 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,659 |
1,638 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,473 |
2,450 |
$29K |
| D4341 |
|
246 |
65 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
160 |
86 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
16 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
14 |
$3K |
| D9430 |
|
24 |
24 |
$768.00 |