| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,410 |
783 |
$913K |
| D1110 |
Prophylaxis - adult |
9,630 |
9,623 |
$519K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,293 |
1,221 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,156 |
1,534 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
6,029 |
6,023 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
2,994 |
2,968 |
$160K |
| D0274 |
Bitewings - four radiographic images |
3,504 |
3,503 |
$113K |
| D9944 |
|
705 |
704 |
$96K |
| D2954 |
|
630 |
398 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,918 |
2,917 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,480 |
1,081 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
748 |
574 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
3,677 |
3,600 |
$48K |
| D4341 |
|
652 |
307 |
$36K |
| D0330 |
Panoramic radiographic image |
820 |
820 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
456 |
138 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,731 |
1,730 |
$24K |
| D2331 |
|
203 |
155 |
$17K |
| D0272 |
Bitewings - two radiographic images |
754 |
753 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
108 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,143 |
992 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
26 |
$13K |
| D5110 |
|
14 |
14 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
451 |
448 |
$7K |
| D2160 |
|
66 |
50 |
$6K |
| D3320 |
|
18 |
13 |
$6K |
| D4910 |
|
82 |
82 |
$4K |
| D2330 |
|
70 |
50 |
$4K |
| D2140 |
|
51 |
35 |
$3K |
| D1320 |
|
316 |
315 |
$2K |
| D2332 |
|
19 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$1K |
| D0190 |
|
162 |
133 |
$15.00 |
| D1999 |
|
282 |
226 |
$0.00 |
| D9986 |
|
190 |
181 |
$0.00 |