| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,131 |
1,279 |
$1.01M |
| D4341 |
|
10,082 |
2,910 |
$701K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,219 |
1,106 |
$564K |
| D1110 |
Prophylaxis - adult |
5,346 |
5,312 |
$424K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,450 |
1,952 |
$396K |
| D3320 |
|
838 |
744 |
$306K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,273 |
4,248 |
$256K |
| D5750 |
|
1,242 |
1,238 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
4,747 |
4,727 |
$237K |
| D2954 |
|
2,188 |
1,316 |
$228K |
| D2394 |
|
2,624 |
2,230 |
$217K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,704 |
1,911 |
$213K |
| D3310 |
|
671 |
409 |
$203K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,188 |
7,324 |
$197K |
| D5751 |
|
840 |
837 |
$160K |
| D0274 |
Bitewings - four radiographic images |
6,335 |
6,306 |
$133K |
| D5110 |
|
140 |
140 |
$88K |
| D4342 |
|
2,075 |
740 |
$87K |
| D5120 |
|
81 |
81 |
$51K |
| D5410 |
|
1,329 |
1,319 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
597 |
246 |
$34K |
| D2335 |
|
286 |
214 |
$33K |
| D5411 |
|
900 |
898 |
$31K |
| D1120 |
Prophylaxis - child |
671 |
670 |
$23K |
| D5761 |
|
114 |
114 |
$20K |
| D3348 |
|
33 |
28 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
279 |
279 |
$13K |
| D0272 |
Bitewings - two radiographic images |
684 |
684 |
$8K |
| D5422 |
|
223 |
223 |
$8K |
| D2332 |
|
54 |
44 |
$4K |