| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
450 |
285 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,861 |
2,840 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
2,080 |
2,071 |
$163K |
| D1120 |
Prophylaxis - child |
3,125 |
3,109 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,373 |
1,171 |
$159K |
| D1110 |
Prophylaxis - adult |
1,716 |
1,702 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,386 |
1,087 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,837 |
946 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,781 |
3,956 |
$87K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,302 |
598 |
$86K |
| D2330 |
|
902 |
431 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,309 |
1,304 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
461 |
258 |
$54K |
| D2954 |
|
485 |
369 |
$51K |
| D1206 |
Topical application of fluoride varnish |
3,080 |
3,066 |
$49K |
| D0350 |
|
4,608 |
1,848 |
$44K |
| D2740 |
Crown - porcelain/ceramic |
90 |
75 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,913 |
1,896 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
490 |
333 |
$39K |
| D4341 |
|
488 |
136 |
$34K |
| D2140 |
|
624 |
315 |
$33K |
| D2160 |
|
354 |
208 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,702 |
1,689 |
$25K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
47 |
44 |
$22K |
| D1351 |
Sealant - per tooth |
467 |
133 |
$18K |
| D9430 |
|
447 |
432 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,182 |
1,177 |
$14K |
| D2331 |
|
149 |
105 |
$12K |
| D1310 |
|
246 |
246 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
900 |
892 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
25 |
$6K |
| D2161 |
|
18 |
16 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$826.00 |
| D0603 |
|
37 |
37 |
$555.00 |