| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,347 |
2,344 |
$146K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
222 |
208 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
2,210 |
2,209 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
2,264 |
2,263 |
$100K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
181 |
98 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,260 |
710 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
601 |
310 |
$71K |
| D4341 |
|
995 |
277 |
$68K |
| D1110 |
Prophylaxis - adult |
742 |
741 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
638 |
319 |
$42K |
| D1120 |
Prophylaxis - child |
1,372 |
1,370 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
757 |
412 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,723 |
1,723 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
173 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
29 |
12 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,496 |
1,032 |
$10K |
| D2954 |
|
93 |
55 |
$10K |
| D3310 |
|
32 |
15 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
505 |
501 |
$6K |
| D2140 |
|
93 |
47 |
$5K |
| D2160 |
|
62 |
49 |
$5K |
| D4342 |
|
90 |
30 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$492.00 |
| D9430 |
|
12 |
12 |
$384.00 |
| D8670 |
Periodic orthodontic treatment visit |
14 |
14 |
$0.00 |