| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,815 |
3,789 |
$245K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
463 |
360 |
$219K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,133 |
7,159 |
$151K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,223 |
712 |
$144K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
308 |
295 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
2,586 |
2,543 |
$130K |
| D1110 |
Prophylaxis - adult |
1,582 |
1,558 |
$128K |
| D0274 |
Bitewings - four radiographic images |
5,789 |
5,737 |
$118K |
| D1120 |
Prophylaxis - child |
2,028 |
1,999 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,123 |
522 |
$72K |
| D9430 |
|
1,742 |
1,680 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,676 |
2,629 |
$31K |
| D2954 |
|
283 |
239 |
$29K |
| D0350 |
|
3,324 |
1,513 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,279 |
2,196 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
302 |
182 |
$20K |
| D3320 |
|
41 |
39 |
$15K |
| D1206 |
Topical application of fluoride varnish |
788 |
787 |
$13K |
| D2160 |
|
154 |
97 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
99 |
$11K |
| D2140 |
|
205 |
108 |
$10K |
| D1351 |
Sealant - per tooth |
181 |
49 |
$3K |
| D9110 |
|
33 |
30 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$873.60 |
| D0272 |
Bitewings - two radiographic images |
39 |
38 |
$400.00 |
| D0270 |
|
14 |
12 |
$50.00 |
| D1330 |
|
445 |
437 |
$0.00 |