| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
770 |
482 |
$358K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,835 |
633 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,543 |
1,533 |
$97K |
| D2954 |
|
694 |
448 |
$68K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
153 |
123 |
$67K |
| D1110 |
Prophylaxis - adult |
770 |
764 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,307 |
1,298 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
744 |
742 |
$50K |
| D9430 |
|
1,583 |
1,387 |
$45K |
| D1120 |
Prophylaxis - child |
813 |
808 |
$34K |
| D2140 |
|
618 |
295 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
417 |
153 |
$28K |
| D2160 |
|
349 |
191 |
$27K |
| D4910 |
|
323 |
322 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,445 |
1,436 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,101 |
1,500 |
$24K |
| D4341 |
|
278 |
82 |
$17K |
| D3320 |
|
36 |
26 |
$13K |
| D0274 |
Bitewings - four radiographic images |
526 |
523 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
806 |
771 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
54 |
$6K |
| D1351 |
Sealant - per tooth |
256 |
74 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
27 |
$5K |
| D1206 |
Topical application of fluoride varnish |
191 |
189 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$2K |