| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,555 |
2,335 |
$1.68M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,702 |
1,507 |
$779K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
8,371 |
3,661 |
$558K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,821 |
7,806 |
$512K |
| D2954 |
|
4,551 |
3,207 |
$472K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,232 |
1,806 |
$381K |
| D4341 |
|
5,132 |
1,455 |
$359K |
| D0210 |
Intraoral - complete series of radiographic images |
6,585 |
6,571 |
$315K |
| D2140 |
|
4,988 |
2,376 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
3,486 |
3,473 |
$221K |
| D2160 |
|
2,635 |
1,628 |
$209K |
| D3320 |
|
492 |
414 |
$178K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,013 |
5,253 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,083 |
853 |
$118K |
| D4910 |
|
1,348 |
1,344 |
$102K |
| D1120 |
Prophylaxis - child |
2,662 |
2,656 |
$101K |
| D2932 |
|
760 |
569 |
$80K |
| D0350 |
|
4,553 |
3,281 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,159 |
3,151 |
$67K |
| D2330 |
|
554 |
323 |
$42K |
| D3310 |
|
135 |
89 |
$41K |
| D4342 |
|
939 |
328 |
$39K |
| D1206 |
Topical application of fluoride varnish |
3,089 |
3,078 |
$38K |
| D1351 |
Sealant - per tooth |
1,343 |
419 |
$33K |
| D1110 |
Prophylaxis - adult |
313 |
313 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,325 |
1,311 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
145 |
$8K |
| D0272 |
Bitewings - two radiographic images |
490 |
490 |
$6K |
| D2335 |
|
35 |
24 |
$4K |
| D9993 |
|
42 |
42 |
$3K |
| D1310 |
|
41 |
41 |
$2K |
| D2332 |
|
17 |
15 |
$1K |
| D0601 |
|
14 |
14 |
$195.00 |