| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,704 |
2,640 |
$89K |
| D0330 |
Panoramic radiographic image |
1,235 |
902 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,013 |
1,629 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,875 |
1,834 |
$34K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
109 |
106 |
$34K |
| D2394 |
|
149 |
137 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
223 |
95 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,349 |
1,326 |
$17K |
| D2950 |
|
296 |
271 |
$14K |
| D3320 |
|
42 |
37 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
487 |
476 |
$13K |
| D2335 |
|
114 |
75 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
269 |
63 |
$10K |
| D7250 |
|
60 |
12 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
544 |
466 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
194 |
194 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$322.79 |
| D3310 |
|
15 |
13 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$0.00 |