| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,544 |
2,430 |
$124K |
| D2740 |
Crown - porcelain/ceramic |
144 |
104 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
1,601 |
1,439 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,030 |
1,969 |
$45K |
| D0274 |
Bitewings - four radiographic images |
362 |
353 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
739 |
661 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
184 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
224 |
221 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
24 |
$5K |
| D1120 |
Prophylaxis - child |
90 |
90 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
52 |
$4K |
| D2950 |
|
18 |
17 |
$3K |
| D9110 |
|
66 |
58 |
$3K |
| D7310 |
|
14 |
12 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
15 |
12 |
$2K |
| D8660 |
|
28 |
26 |
$558.00 |
| D0270 |
|
26 |
24 |
$266.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$172.00 |