| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
911 |
569 |
$431K |
| D0120 |
Periodic oral evaluation - established patient |
1,765 |
1,749 |
$136K |
| D9110 |
|
1,850 |
1,631 |
$116K |
| D1110 |
Prophylaxis - adult |
1,253 |
1,243 |
$109K |
| D1120 |
Prophylaxis - child |
1,354 |
1,340 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
925 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,929 |
1,908 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
369 |
156 |
$44K |
| D2954 |
|
306 |
239 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
69 |
66 |
$32K |
| D1351 |
Sealant - per tooth |
867 |
163 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
644 |
642 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,387 |
1,377 |
$29K |
| D9430 |
|
795 |
739 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,435 |
1,423 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,144 |
1,135 |
$17K |
| D2161 |
|
63 |
45 |
$5K |
| D7510 |
|
59 |
54 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
31 |
$3K |
| D2140 |
|
43 |
24 |
$2K |