| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,171 |
4,166 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
5,191 |
5,185 |
$97K |
| D0330 |
Panoramic radiographic image |
2,325 |
2,325 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
861 |
723 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,693 |
2,681 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
51 |
49 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,914 |
1,914 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
134 |
109 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,242 |
1,237 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,375 |
1,372 |
$6K |
| D2331 |
|
70 |
52 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
83 |
$5K |
| D4341 |
|
51 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
69 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
29 |
$1K |
| D9944 |
|
15 |
15 |
$1K |
| D9940 |
|
13 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$334.48 |
| D9110 |
|
27 |
27 |
$282.40 |