| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,789 |
2,427 |
$1.80M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,721 |
2,541 |
$1.25M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,679 |
1,965 |
$671K |
| D3320 |
|
1,673 |
1,383 |
$610K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,696 |
8,649 |
$551K |
| D2954 |
|
4,641 |
3,280 |
$476K |
| D0210 |
Intraoral - complete series of radiographic images |
6,467 |
6,428 |
$306K |
| D3310 |
|
977 |
634 |
$294K |
| D2931 |
|
1,521 |
1,199 |
$191K |
| D1110 |
Prophylaxis - adult |
1,875 |
1,869 |
$159K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,865 |
6,026 |
$145K |
| D0274 |
Bitewings - four radiographic images |
4,940 |
4,915 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,165 |
1,160 |
$71K |
| D7250 |
|
527 |
108 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,901 |
2,879 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
551 |
200 |
$31K |
| D4341 |
|
390 |
107 |
$25K |
| D1120 |
Prophylaxis - child |
736 |
727 |
$25K |
| D3221 |
|
270 |
257 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,108 |
1,094 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
133 |
116 |
$9K |
| D1351 |
Sealant - per tooth |
311 |
59 |
$6K |
| D0330 |
Panoramic radiographic image |
171 |
169 |
$5K |
| D5211 |
|
12 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
41 |
$3K |
| D0350 |
|
254 |
159 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
24 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$873.60 |