| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,625 |
1,077 |
$770K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,182 |
2,797 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
3,957 |
3,929 |
$251K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,575 |
3,542 |
$221K |
| D1110 |
Prophylaxis - adult |
2,387 |
2,357 |
$204K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
360 |
322 |
$167K |
| D1120 |
Prophylaxis - child |
3,665 |
3,628 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,140 |
599 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,518 |
6,146 |
$129K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,170 |
774 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,696 |
1,023 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,940 |
1,917 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,941 |
6,870 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,713 |
3,679 |
$78K |
| D4341 |
|
859 |
370 |
$60K |
| D3320 |
|
129 |
117 |
$47K |
| D4910 |
|
270 |
260 |
$21K |
| D1351 |
Sealant - per tooth |
912 |
244 |
$19K |
| D0350 |
|
1,447 |
1,118 |
$19K |
| D9430 |
|
535 |
530 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
524 |
519 |
$6K |
| D0272 |
Bitewings - two radiographic images |
531 |
527 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
15 |
$2K |
| D2330 |
|
19 |
12 |
$1K |