| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,994 |
2,984 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,865 |
3,842 |
$119K |
| D1120 |
Prophylaxis - child |
3,099 |
3,073 |
$103K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
171 |
118 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,533 |
4,494 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
909 |
908 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
718 |
372 |
$47K |
| D1110 |
Prophylaxis - adult |
436 |
432 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
769 |
768 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,693 |
2,673 |
$31K |
| D1351 |
Sealant - per tooth |
778 |
223 |
$17K |
| D2140 |
|
300 |
164 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
59 |
25 |
$14K |
| D4341 |
|
167 |
46 |
$11K |
| D7111 |
|
171 |
79 |
$10K |
| D2954 |
|
69 |
50 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$7K |
| D9430 |
|
106 |
103 |
$3K |
| D4910 |
|
44 |
44 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
139 |
$1K |
| D0350 |
|
36 |
14 |
$150.00 |