| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,703 |
2,632 |
$92K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
555 |
233 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
830 |
378 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,517 |
2,458 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,878 |
1,831 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,817 |
1,767 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
67 |
47 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
392 |
383 |
$17K |
| D0330 |
Panoramic radiographic image |
1,090 |
1,059 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
624 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
538 |
515 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,624 |
1,557 |
$13K |
| D1206 |
Topical application of fluoride varnish |
75 |
74 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
105 |
$606.21 |