| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
736 |
617 |
$362K |
| D1110 |
Prophylaxis - adult |
6,828 |
6,802 |
$252K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
385 |
327 |
$155K |
| D2954 |
|
769 |
680 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
5,763 |
5,739 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,290 |
2,285 |
$58K |
| D0274 |
Bitewings - four radiographic images |
5,203 |
5,170 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
8,264 |
8,149 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,843 |
7,145 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,230 |
1,228 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
488 |
273 |
$44K |
| D9310 |
|
831 |
826 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,677 |
1,642 |
$37K |
| D4341 |
|
302 |
110 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
24 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
466 |
189 |
$13K |
| D0330 |
Panoramic radiographic image |
400 |
400 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
135 |
$9K |
| D9110 |
|
437 |
436 |
$6K |
| D1120 |
Prophylaxis - child |
208 |
208 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
45 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
29 |
$3K |
| D9910 |
|
258 |
258 |
$1K |
| D2140 |
|
33 |
13 |
$1K |
| D3910 |
|
311 |
289 |
$1K |
| D0180 |
|
50 |
50 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$825.00 |
| D9243 |
|
37 |
37 |
$803.00 |
| D0270 |
|
263 |
263 |
$789.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
54 |
$650.00 |
| D9610 |
|
319 |
309 |
$638.00 |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$605.00 |
| D9239 |
|
24 |
24 |
$259.00 |