| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,585 |
2,583 |
$134K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
235 |
181 |
$112K |
| D1120 |
Prophylaxis - child |
1,948 |
1,944 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
616 |
338 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,158 |
1,151 |
$68K |
| D4910 |
|
600 |
599 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
988 |
984 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,202 |
3,880 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,089 |
2,085 |
$38K |
| D4341 |
|
450 |
133 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,281 |
2,276 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
435 |
201 |
$23K |
| D1110 |
Prophylaxis - adult |
274 |
272 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
978 |
954 |
$11K |
| D9430 |
|
323 |
312 |
$10K |
| D0240 |
|
1,616 |
662 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
98 |
$10K |
| D2954 |
|
18 |
12 |
$2K |
| D0350 |
|
190 |
87 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$567.50 |
| D1330 |
|
65 |
65 |
$0.00 |