| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,661 |
3,647 |
$314K |
| D0120 |
Periodic oral evaluation - established patient |
3,798 |
3,790 |
$225K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
744 |
481 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,310 |
1,307 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,670 |
1,662 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,806 |
4,790 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
124 |
100 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,844 |
4,661 |
$57K |
| D9110 |
|
820 |
803 |
$51K |
| D1120 |
Prophylaxis - child |
1,008 |
1,008 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
542 |
454 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,233 |
2,442 |
$21K |
| D9430 |
|
654 |
651 |
$20K |
| D4910 |
|
176 |
176 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
14 |
$2K |
| D2954 |
|
15 |
14 |
$2K |
| D2330 |
|
15 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$873.60 |
| D2140 |
|
16 |
14 |
$873.60 |
| D0350 |
|
20 |
15 |
$182.40 |