| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,375 |
1,102 |
$654K |
| D4341 |
|
3,223 |
840 |
$219K |
| D1110 |
Prophylaxis - adult |
2,499 |
2,492 |
$213K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,634 |
2,621 |
$166K |
| D5750 |
|
776 |
776 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
2,713 |
2,703 |
$150K |
| D2954 |
|
1,343 |
1,121 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,033 |
913 |
$115K |
| D2791 |
|
203 |
188 |
$97K |
| D3320 |
|
264 |
243 |
$96K |
| D3310 |
|
313 |
250 |
$95K |
| D4910 |
|
1,179 |
1,176 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,772 |
1,766 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,018 |
2,915 |
$73K |
| D5751 |
|
315 |
314 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
427 |
301 |
$51K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
51 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,702 |
1,694 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,633 |
1,625 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
255 |
220 |
$17K |
| D9430 |
|
488 |
488 |
$16K |
| D3221 |
|
162 |
137 |
$10K |
| D5741 |
|
95 |
95 |
$9K |
| D5740 |
|
37 |
37 |
$4K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$3K |