| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,610 |
1,231 |
$762K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,219 |
2,439 |
$494K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,299 |
4,750 |
$484K |
| D2140 |
|
8,979 |
4,910 |
$481K |
| D4341 |
|
6,780 |
2,055 |
$462K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
985 |
933 |
$453K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,748 |
5,732 |
$359K |
| D1110 |
Prophylaxis - adult |
3,014 |
3,006 |
$239K |
| D0210 |
Intraoral - complete series of radiographic images |
4,407 |
4,393 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
3,814 |
3,808 |
$195K |
| D9430 |
|
4,814 |
4,740 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,510 |
8,944 |
$143K |
| D2160 |
|
1,478 |
1,177 |
$117K |
| D3320 |
|
319 |
276 |
$116K |
| D0274 |
Bitewings - four radiographic images |
4,710 |
4,695 |
$97K |
| D0350 |
|
7,968 |
4,490 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,539 |
4,526 |
$55K |
| D1120 |
Prophylaxis - child |
1,354 |
1,353 |
$48K |
| D4910 |
|
615 |
615 |
$47K |
| D2330 |
|
392 |
270 |
$30K |
| D3310 |
|
71 |
53 |
$21K |
| D4342 |
|
382 |
150 |
$16K |
| D2952 |
|
135 |
127 |
$14K |
| D0270 |
|
2,987 |
2,974 |
$13K |
| D2331 |
|
170 |
127 |
$13K |
| D2931 |
|
91 |
78 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
80 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,556 |
1,541 |
$9K |
| D2332 |
|
41 |
30 |
$3K |