| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,520 |
2,501 |
$216K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
399 |
299 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
2,550 |
2,537 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,036 |
2,023 |
$130K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,494 |
749 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,584 |
3,416 |
$77K |
| D4341 |
|
1,124 |
309 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,412 |
1,399 |
$66K |
| D1120 |
Prophylaxis - child |
1,656 |
1,652 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,262 |
4,239 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
428 |
281 |
$51K |
| D2952 |
|
350 |
269 |
$36K |
| D9210 |
|
1,313 |
1,107 |
$33K |
| D0350 |
|
1,798 |
1,013 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,817 |
1,809 |
$21K |
| D2160 |
|
218 |
125 |
$17K |
| D2140 |
|
233 |
122 |
$13K |
| D7510 |
|
182 |
178 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
933 |
903 |
$11K |
| D0274 |
Bitewings - four radiographic images |
520 |
518 |
$11K |
| D2931 |
|
64 |
44 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
29 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2332 |
|
31 |
14 |
$2K |
| D3221 |
|
29 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$2K |
| D1999 |
|
148 |
127 |
$120.00 |