| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
412 |
213 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
3,513 |
3,510 |
$192K |
| D1120 |
Prophylaxis - child |
3,134 |
3,125 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,382 |
4,783 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,203 |
1,201 |
$76K |
| D1110 |
Prophylaxis - adult |
828 |
828 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,210 |
3,204 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,403 |
4,395 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
646 |
361 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
559 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
177 |
93 |
$20K |
| D1351 |
Sealant - per tooth |
724 |
185 |
$16K |
| D2160 |
|
101 |
64 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
12 |
$8K |
| D0272 |
Bitewings - two radiographic images |
483 |
483 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
38 |
$4K |
| D4341 |
|
51 |
14 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
107 |
106 |
$1K |