| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,635 |
2,573 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
2,619 |
2,563 |
$58K |
| D9110 |
|
1,292 |
1,201 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
296 |
233 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,505 |
2,368 |
$38K |
| D0274 |
Bitewings - four radiographic images |
799 |
785 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,846 |
1,625 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
126 |
$17K |
| D2954 |
|
61 |
44 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
263 |
259 |
$11K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
12 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
95 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
95 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
53 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
83 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
120 |
$3K |
| D1120 |
Prophylaxis - child |
73 |
70 |
$3K |
| D1206 |
Topical application of fluoride varnish |
107 |
106 |
$3K |
| D2335 |
|
15 |
12 |
$2K |
| D0180 |
|
21 |
21 |
$666.00 |