| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
723 |
538 |
$337K |
| D1110 |
Prophylaxis - adult |
3,898 |
3,877 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
5,459 |
5,437 |
$270K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,856 |
2,842 |
$175K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,574 |
1,645 |
$145K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,960 |
7,193 |
$144K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
313 |
278 |
$142K |
| D1120 |
Prophylaxis - child |
3,947 |
3,933 |
$138K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,328 |
975 |
$84K |
| D1351 |
Sealant - per tooth |
3,269 |
677 |
$82K |
| D0274 |
Bitewings - four radiographic images |
4,004 |
3,969 |
$80K |
| D2954 |
|
603 |
451 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
866 |
860 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
280 |
224 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,313 |
3,211 |
$30K |
| D9430 |
|
753 |
740 |
$23K |
| D3320 |
|
60 |
49 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,471 |
1,465 |
$15K |
| D2140 |
|
137 |
105 |
$7K |
| D3310 |
|
16 |
12 |
$5K |
| D2330 |
|
58 |
39 |
$4K |
| D1330 |
|
83 |
54 |
$0.00 |