| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,334 |
1,385 |
$307K |
| D1110 |
Prophylaxis - adult |
3,852 |
3,819 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,588 |
670 |
$112K |
| D9110 |
|
1,587 |
1,532 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,232 |
3,068 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,148 |
1,135 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,539 |
1,525 |
$35K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
41 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
217 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
318 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
460 |
456 |
$13K |
| D1120 |
Prophylaxis - child |
157 |
157 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
184 |
182 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
535 |
371 |
$6K |