| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,198 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
906 |
522 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,046 |
1,042 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
967 |
$46K |
| D1120 |
Prophylaxis - child |
1,031 |
1,029 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
70 |
63 |
$33K |
| D2140 |
|
541 |
292 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
180 |
115 |
$21K |
| D4910 |
|
243 |
243 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,935 |
1,950 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
27 |
$13K |
| D9430 |
|
401 |
399 |
$13K |
| D0274 |
Bitewings - four radiographic images |
571 |
566 |
$12K |
| D1206 |
Topical application of fluoride varnish |
446 |
444 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
421 |
421 |
$4K |
| D1110 |
Prophylaxis - adult |
37 |
36 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
258 |
$3K |
| D2160 |
|
18 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$788.00 |
| D0350 |
|
82 |
42 |
$787.20 |