| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,047 |
2,041 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
2,985 |
2,974 |
$169K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,571 |
5,166 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,281 |
1,279 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,283 |
3,272 |
$70K |
| D1120 |
Prophylaxis - child |
1,345 |
1,336 |
$50K |
| D9430 |
|
1,187 |
1,126 |
$37K |
| D4341 |
|
432 |
115 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,556 |
2,404 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,650 |
1,640 |
$29K |
| D4910 |
|
321 |
319 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
188 |
136 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,761 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
111 |
90 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$918.40 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$170.00 |