| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,519 |
2,512 |
$114K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
209 |
133 |
$88K |
| D2752 |
|
131 |
114 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,233 |
2,225 |
$51K |
| D0330 |
Panoramic radiographic image |
859 |
859 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,130 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
126 |
105 |
$9K |
| D2952 |
|
87 |
76 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
540 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
257 |
$6K |
| D0274 |
Bitewings - four radiographic images |
246 |
245 |
$6K |
| D0272 |
Bitewings - two radiographic images |
265 |
265 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$889.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
86 |
$635.80 |