| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,212 |
1,209 |
$77K |
| D1110 |
Prophylaxis - adult |
801 |
795 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
901 |
896 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
46 |
31 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
175 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
375 |
375 |
$17K |
| D5750 |
|
66 |
66 |
$13K |
| D1206 |
Topical application of fluoride varnish |
575 |
573 |
$10K |
| D5110 |
|
13 |
13 |
$8K |
| D5751 |
|
13 |
13 |
$2K |
| D5411 |
|
63 |
63 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
66 |
$963.60 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |