| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,519 |
2,513 |
$150K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
761 |
449 |
$87K |
| D1110 |
Prophylaxis - adult |
975 |
973 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,400 |
1,398 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
561 |
276 |
$32K |
| D0330 |
Panoramic radiographic image |
826 |
822 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
43 |
31 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
517 |
516 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,608 |
1,081 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
949 |
918 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
849 |
846 |
$10K |
| D0350 |
|
987 |
270 |
$9K |
| D1206 |
Topical application of fluoride varnish |
359 |
359 |
$6K |
| D9430 |
|
169 |
167 |
$5K |
| D2954 |
|
40 |
29 |
$4K |
| D4910 |
|
53 |
53 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
16 |
$1K |
| D0274 |
Bitewings - four radiographic images |
63 |
63 |
$1K |
| D0272 |
Bitewings - two radiographic images |
101 |
101 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$780.00 |