| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,895 |
4,864 |
$264K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
494 |
304 |
$235K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,580 |
765 |
$184K |
| D1120 |
Prophylaxis - child |
4,943 |
4,908 |
$182K |
| D1110 |
Prophylaxis - adult |
1,977 |
1,959 |
$167K |
| D1351 |
Sealant - per tooth |
6,238 |
1,665 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,207 |
2,197 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
2,551 |
2,536 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,488 |
4,907 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,978 |
6,947 |
$83K |
| D2160 |
|
969 |
609 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,018 |
3,002 |
$64K |
| D2954 |
|
485 |
298 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
873 |
446 |
$49K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
98 |
66 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
418 |
274 |
$28K |
| D2161 |
|
293 |
219 |
$25K |
| D4341 |
|
271 |
73 |
$19K |
| D9993 |
|
265 |
265 |
$17K |
| D1310 |
|
319 |
318 |
$14K |
| D0272 |
Bitewings - two radiographic images |
992 |
984 |
$12K |
| D9430 |
|
196 |
187 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
292 |
287 |
$3K |
| D4910 |
|
19 |
19 |
$1K |
| D0603 |
|
41 |
40 |
$570.00 |