| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,473 |
5,458 |
$300K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
623 |
416 |
$295K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,561 |
3,556 |
$224K |
| D1120 |
Prophylaxis - child |
5,309 |
5,296 |
$193K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,321 |
8,088 |
$176K |
| D1110 |
Prophylaxis - adult |
1,337 |
1,331 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,380 |
2,377 |
$112K |
| D0274 |
Bitewings - four radiographic images |
5,219 |
5,202 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
812 |
440 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,030 |
7,011 |
$86K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,266 |
765 |
$85K |
| D2160 |
|
788 |
470 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,067 |
455 |
$61K |
| D1351 |
Sealant - per tooth |
2,087 |
488 |
$54K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
58 |
51 |
$27K |
| D0330 |
Panoramic radiographic image |
638 |
634 |
$19K |
| D0272 |
Bitewings - two radiographic images |
959 |
959 |
$11K |
| D4341 |
|
104 |
27 |
$7K |
| D3320 |
|
15 |
14 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
192 |
$2K |
| D0350 |
|
39 |
27 |
$374.40 |