| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
493 |
145 |
$59K |
| D1110 |
Prophylaxis - adult |
704 |
619 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
58 |
25 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
782 |
671 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
110 |
$11K |
| D9243 |
|
29 |
26 |
$10K |
| D0274 |
Bitewings - four radiographic images |
235 |
211 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
339 |
282 |
$6K |
| D4910 |
|
50 |
43 |
$5K |
| D4341 |
|
24 |
12 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
84 |
$5K |
| D9239 |
|
27 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
55 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$721.10 |