| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
433 |
325 |
$243K |
| D1110 |
Prophylaxis - adult |
4,459 |
4,452 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
3,973 |
3,970 |
$90K |
| D4341 |
|
1,462 |
733 |
$81K |
| D2160 |
|
944 |
770 |
$72K |
| D0274 |
Bitewings - four radiographic images |
3,267 |
3,266 |
$71K |
| D2954 |
|
726 |
507 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
2,009 |
1,879 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
830 |
731 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
5,732 |
5,531 |
$60K |
| D2331 |
|
656 |
551 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
845 |
660 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,857 |
1,856 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
433 |
$36K |
| D1120 |
Prophylaxis - child |
994 |
991 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
475 |
441 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
48 |
44 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,902 |
3,884 |
$21K |
| D2140 |
|
279 |
264 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,236 |
1,233 |
$14K |
| D9110 |
|
674 |
674 |
$13K |
| D1351 |
Sealant - per tooth |
74 |
60 |
$6K |
| D2330 |
|
91 |
90 |
$5K |
| D3320 |
|
12 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
184 |
184 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
149 |
$2K |
| D0602 |
|
25 |
25 |
$0.00 |