| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
841 |
581 |
$400K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,864 |
978 |
$219K |
| D1110 |
Prophylaxis - adult |
2,111 |
2,101 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
2,815 |
2,797 |
$154K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,360 |
2,353 |
$144K |
| D1120 |
Prophylaxis - child |
2,044 |
2,031 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,104 |
807 |
$74K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
155 |
140 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,260 |
3,660 |
$62K |
| D2140 |
|
972 |
704 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,071 |
1,065 |
$50K |
| D9430 |
|
1,458 |
1,387 |
$46K |
| D2954 |
|
402 |
312 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,843 |
1,835 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,862 |
1,839 |
$22K |
| D2160 |
|
38 |
32 |
$3K |