| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,411 |
1,063 |
$730K |
| D0210 |
Intraoral - complete series of radiographic images |
2,511 |
2,499 |
$94K |
| D2954 |
|
1,005 |
783 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
621 |
272 |
$59K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
195 |
173 |
$52K |
| D1110 |
Prophylaxis - adult |
2,059 |
2,051 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,207 |
1,198 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,361 |
1,353 |
$29K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
58 |
57 |
$29K |
| D9222 |
|
178 |
173 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
781 |
762 |
$15K |
| D9310 |
|
549 |
540 |
$13K |
| D3320 |
|
29 |
26 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
59 |
$6K |
| D1120 |
Prophylaxis - child |
290 |
288 |
$6K |
| D3310 |
|
19 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
776 |
759 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,993 |
416 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
163 |
162 |
$1K |
| D0274 |
Bitewings - four radiographic images |
282 |
276 |
$117.45 |