| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,438 |
1,338 |
$1.16M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,128 |
892 |
$523K |
| D2954 |
|
2,539 |
1,436 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
3,383 |
3,364 |
$185K |
| D3320 |
|
397 |
296 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,953 |
1,941 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,793 |
5,487 |
$105K |
| D1110 |
Prophylaxis - adult |
1,026 |
1,017 |
$91K |
| D4910 |
|
782 |
782 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,700 |
2,679 |
$57K |
| D1120 |
Prophylaxis - child |
1,557 |
1,533 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,130 |
1,124 |
$53K |
| D4341 |
|
533 |
185 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
867 |
804 |
$33K |
| D0330 |
Panoramic radiographic image |
957 |
953 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
78 |
$17K |
| D3310 |
|
54 |
24 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,239 |
1,232 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
785 |
772 |
$9K |
| D9430 |
|
285 |
280 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
51 |
$6K |
| D4342 |
|
90 |
27 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
33 |
$3K |
| D1206 |
Topical application of fluoride varnish |
157 |
157 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
24 |
$2K |
| D2931 |
|
17 |
12 |
$2K |
| D2140 |
|
31 |
19 |
$2K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$576.00 |
| D0350 |
|
42 |
25 |
$312.00 |
| D1999 |
|
42 |
42 |
$138.00 |