| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
799 |
517 |
$357K |
| D1110 |
Prophylaxis - adult |
3,114 |
3,110 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,883 |
1,881 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,608 |
2,606 |
$59K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
136 |
120 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,342 |
2,336 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
802 |
479 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,356 |
2,355 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
5,548 |
5,071 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
486 |
264 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
993 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
424 |
232 |
$22K |
| D3320 |
|
45 |
42 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,042 |
3,390 |
$14K |
| D1120 |
Prophylaxis - child |
471 |
465 |
$13K |
| D1351 |
Sealant - per tooth |
701 |
88 |
$12K |
| D2950 |
|
197 |
156 |
$11K |
| D0330 |
Panoramic radiographic image |
520 |
518 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
347 |
342 |
$4K |
| D9310 |
|
207 |
206 |
$2K |
| D2332 |
|
45 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
29 |
$2K |
| D0603 |
|
177 |
175 |
$2K |
| D2954 |
|
16 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
79 |
$1K |
| D9920 |
|
63 |
58 |
$1K |
| D0270 |
|
231 |
229 |
$1K |
| D0601 |
|
14 |
14 |
$70.00 |
| D1999 |
|
1,957 |
1,597 |
$0.00 |
| D1330 |
|
316 |
315 |
$0.00 |