| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
4,504 |
1,275 |
$308K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
619 |
467 |
$294K |
| D0120 |
Periodic oral evaluation - established patient |
2,942 |
2,934 |
$152K |
| D1110 |
Prophylaxis - adult |
1,541 |
1,540 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,931 |
1,922 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,700 |
824 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
2,041 |
2,034 |
$95K |
| D4910 |
|
1,099 |
1,093 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
545 |
413 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,816 |
2,139 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,085 |
2,084 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
46 |
39 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,614 |
1,602 |
$19K |
| D2954 |
|
183 |
158 |
$19K |
| D1120 |
Prophylaxis - child |
361 |
360 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
224 |
175 |
$15K |
| D2394 |
|
127 |
108 |
$11K |
| D3310 |
|
26 |
12 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$7K |
| D4342 |
|
141 |
52 |
$6K |
| D0274 |
Bitewings - four radiographic images |
174 |
174 |
$4K |
| D5850 |
|
48 |
48 |
$3K |
| D5851 |
|
24 |
24 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |