| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,960 |
1,110 |
$268K |
| D1110 |
Prophylaxis - adult |
1,898 |
1,893 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
2,566 |
2,560 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
2,232 |
2,229 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,606 |
1,603 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,950 |
2,594 |
$44K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
85 |
56 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
272 |
209 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,998 |
1,980 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,710 |
1,709 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
35 |
27 |
$16K |
| D3320 |
|
41 |
33 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,178 |
1,177 |
$14K |
| D3310 |
|
36 |
26 |
$11K |
| D9430 |
|
350 |
346 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
152 |
87 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
47 |
$4K |
| D1120 |
Prophylaxis - child |
32 |
32 |
$960.00 |
| D4342 |
|
20 |
13 |
$840.00 |