| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,314 |
758 |
$623K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,271 |
1,140 |
$587K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,255 |
2,672 |
$350K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,840 |
4,822 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
4,956 |
4,926 |
$261K |
| D2140 |
|
4,193 |
1,971 |
$226K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,774 |
1,122 |
$208K |
| D3320 |
|
519 |
437 |
$189K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,851 |
7,869 |
$172K |
| D0274 |
Bitewings - four radiographic images |
6,653 |
6,622 |
$139K |
| D2954 |
|
1,281 |
751 |
$134K |
| D1120 |
Prophylaxis - child |
3,118 |
3,102 |
$112K |
| D2160 |
|
1,322 |
892 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
2,225 |
2,214 |
$101K |
| D9430 |
|
1,950 |
1,865 |
$62K |
| D4341 |
|
831 |
216 |
$58K |
| D3310 |
|
184 |
106 |
$55K |
| D1206 |
Topical application of fluoride varnish |
3,812 |
3,791 |
$43K |
| D1110 |
Prophylaxis - adult |
365 |
365 |
$32K |
| D4910 |
|
172 |
171 |
$13K |
| D0350 |
|
1,210 |
527 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
850 |
837 |
$10K |
| D1351 |
Sealant - per tooth |
251 |
55 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
53 |
$5K |
| D2330 |
|
56 |
38 |
$4K |
| D0272 |
Bitewings - two radiographic images |
268 |
267 |
$3K |