| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,370 |
1,369 |
$90K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
184 |
125 |
$87K |
| D1110 |
Prophylaxis - adult |
978 |
968 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
504 |
503 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
805 |
804 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,617 |
1,220 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,423 |
1,411 |
$19K |
| D2954 |
|
112 |
72 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
38 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D0274 |
Bitewings - four radiographic images |
225 |
225 |
$5K |
| D0272 |
Bitewings - two radiographic images |
401 |
400 |
$5K |
| D9430 |
|
132 |
131 |
$4K |
| D1120 |
Prophylaxis - child |
98 |
98 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
28 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
50 |
$600.00 |