| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
895 |
$59K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
112 |
85 |
$53K |
| D1110 |
Prophylaxis - adult |
469 |
469 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
722 |
722 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
293 |
155 |
$19K |
| D4341 |
|
195 |
53 |
$14K |
| D4910 |
|
147 |
146 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
592 |
590 |
$9K |
| D2140 |
|
145 |
83 |
$8K |
| D2160 |
|
96 |
55 |
$8K |
| D1120 |
Prophylaxis - child |
128 |
128 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
26 |
$6K |
| D9430 |
|
182 |
170 |
$6K |
| D1320 |
|
341 |
339 |
$6K |
| D0350 |
|
411 |
156 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
836 |
210 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
27 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
63 |
62 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
84 |
$1K |