| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
486 |
279 |
$227K |
| D1110 |
Prophylaxis - adult |
2,613 |
2,584 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,258 |
3,232 |
$214K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,123 |
849 |
$121K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,255 |
702 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
986 |
981 |
$47K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
77 |
67 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,662 |
1,606 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,241 |
1,227 |
$15K |
| D3320 |
|
31 |
26 |
$11K |
| D2160 |
|
124 |
94 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
42 |
$9K |
| D3310 |
|
20 |
12 |
$6K |
| D2140 |
|
101 |
67 |
$5K |
| D4341 |
|
70 |
25 |
$5K |
| D1120 |
Prophylaxis - child |
90 |
87 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
42 |
42 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$252.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |