| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
950 |
912 |
$88K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,221 |
502 |
$77K |
| D2740 |
Crown - porcelain/ceramic |
90 |
49 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
336 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,621 |
1,538 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,982 |
971 |
$17K |
| D0274 |
Bitewings - four radiographic images |
428 |
421 |
$11K |
| D1110 |
Prophylaxis - adult |
162 |
160 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
214 |
214 |
$6K |
| D1120 |
Prophylaxis - child |
208 |
208 |
$6K |
| D1206 |
Topical application of fluoride varnish |
271 |
271 |
$6K |
| D2950 |
|
51 |
26 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$780.21 |