| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,547 |
1,309 |
$227K |
| D2740 |
Crown - porcelain/ceramic |
230 |
88 |
$138K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,195 |
775 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
465 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
187 |
174 |
$26K |
| D2950 |
|
159 |
70 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
127 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,751 |
1,533 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,541 |
1,282 |
$7K |
| D2160 |
|
88 |
55 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
403 |
$5K |
| D2140 |
|
126 |
57 |
$5K |
| D4355 |
|
254 |
231 |
$4K |
| D2161 |
|
19 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
289 |
246 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
78 |
73 |
$0.00 |
| D1120 |
Prophylaxis - child |
39 |
39 |
$0.00 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$0.00 |