| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,332 |
1,326 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,222 |
1,216 |
$57K |
| D4341 |
|
455 |
132 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
243 |
96 |
$28K |
| D1110 |
Prophylaxis - adult |
220 |
220 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
236 |
235 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
248 |
95 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
141 |
97 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
14 |
$7K |
| D1120 |
Prophylaxis - child |
125 |
125 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
868 |
169 |
$3K |
| D2140 |
|
42 |
30 |
$2K |
| D0274 |
Bitewings - four radiographic images |
104 |
104 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
156 |
154 |
$2K |
| D2954 |
|
14 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$76.00 |