| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,637 |
9,609 |
$474K |
| D1120 |
Prophylaxis - child |
9,600 |
9,570 |
$337K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
414 |
247 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,595 |
2,594 |
$162K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,553 |
13,584 |
$149K |
| D0272 |
Bitewings - two radiographic images |
9,874 |
9,839 |
$116K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
228 |
161 |
$105K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
517 |
347 |
$61K |
| D1110 |
Prophylaxis - adult |
609 |
609 |
$54K |
| D2954 |
|
426 |
253 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
406 |
222 |
$24K |
| D9430 |
|
733 |
721 |
$23K |
| D4341 |
|
321 |
110 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
155 |
$20K |
| D3320 |
|
37 |
32 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
725 |
725 |
$11K |
| D2140 |
|
146 |
57 |
$8K |
| D0274 |
Bitewings - four radiographic images |
232 |
232 |
$5K |
| D1351 |
Sealant - per tooth |
133 |
30 |
$4K |
| D0270 |
|
474 |
472 |
$2K |
| D3221 |
|
33 |
26 |
$2K |
| D1999 |
|
125 |
125 |
$90.00 |