| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,759 |
1,553 |
$304K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
443 |
287 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,045 |
3,027 |
$185K |
| D1110 |
Prophylaxis - adult |
1,468 |
1,452 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
2,137 |
2,118 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
1,933 |
1,921 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,586 |
3,481 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,607 |
2,584 |
$39K |
| D4341 |
|
518 |
167 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,885 |
1,867 |
$31K |
| D2954 |
|
212 |
166 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,062 |
2,009 |
$20K |
| D1120 |
Prophylaxis - child |
555 |
549 |
$20K |
| D9430 |
|
213 |
212 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
144 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$415.00 |
| D0603 |
|
16 |
16 |
$0.00 |
| D1310 |
|
15 |
15 |
$0.00 |