| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,212 |
2,583 |
$339K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
590 |
440 |
$280K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,819 |
2,810 |
$175K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,403 |
764 |
$160K |
| D2140 |
|
2,767 |
1,554 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
2,678 |
2,671 |
$137K |
| D2160 |
|
1,774 |
1,190 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
2,623 |
2,618 |
$119K |
| D2740 |
Crown - porcelain/ceramic |
208 |
109 |
$99K |
| D1110 |
Prophylaxis - adult |
1,130 |
1,125 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,271 |
2,966 |
$64K |
| D1120 |
Prophylaxis - child |
1,524 |
1,518 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,161 |
2,155 |
$25K |
| D9430 |
|
433 |
422 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
878 |
865 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
67 |
$9K |
| D1351 |
Sealant - per tooth |
234 |
67 |
$7K |
| D2330 |
|
84 |
50 |
$6K |
| D4341 |
|
86 |
24 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$1K |
| D9110 |
|
13 |
12 |
$819.00 |