| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,475 |
3,953 |
$48K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
213 |
205 |
$36K |
| D2950 |
|
894 |
797 |
$34K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
225 |
194 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
791 |
575 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,628 |
4,168 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,628 |
1,580 |
$11K |
| D0330 |
Panoramic radiographic image |
859 |
823 |
$10K |
| D1110 |
Prophylaxis - adult |
926 |
905 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
1,197 |
1,185 |
$9K |
| D1120 |
Prophylaxis - child |
513 |
491 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,629 |
1,190 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
42 |
39 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
822 |
816 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
290 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
82 |
$3K |
| D0272 |
Bitewings - two radiographic images |
69 |
69 |
$459.87 |
| D1206 |
Topical application of fluoride varnish |
54 |
54 |
$275.79 |
| D1999 |
|
864 |
694 |
$156.00 |
| D0601 |
|
13 |
13 |
$0.00 |
| D0603 |
|
13 |
12 |
$0.00 |