| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,654 |
2,269 |
$975.83 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
63 |
37 |
$783.88 |
| D1110 |
Prophylaxis - adult |
649 |
613 |
$460.85 |
| D0220 |
Intraoral - periapical first radiographic image |
2,791 |
2,418 |
$386.05 |
| D0120 |
Periodic oral evaluation - established patient |
626 |
602 |
$341.04 |
| D0274 |
Bitewings - four radiographic images |
1,173 |
1,086 |
$308.18 |
| D1120 |
Prophylaxis - child |
54 |
48 |
$264.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
125 |
108 |
$108.92 |
| D2950 |
|
107 |
92 |
$97.70 |
| D0330 |
Panoramic radiographic image |
308 |
261 |
$91.06 |
| D1206 |
Topical application of fluoride varnish |
54 |
54 |
$47.33 |
| D0230 |
Intraoral - periapical each additional radiographic image |
877 |
432 |
$36.40 |
| D1999 |
|
377 |
285 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
38 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
69 |
$0.00 |