| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
821 |
521 |
$388K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,829 |
2,807 |
$387K |
| D0120 |
Periodic oral evaluation - established patient |
6,519 |
6,492 |
$323K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,859 |
3,844 |
$242K |
| D1120 |
Prophylaxis - child |
5,791 |
5,742 |
$198K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,563 |
8,274 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
3,324 |
3,312 |
$153K |
| D1351 |
Sealant - per tooth |
6,120 |
1,611 |
$146K |
| D0274 |
Bitewings - four radiographic images |
6,415 |
6,367 |
$133K |
| D2140 |
|
2,339 |
1,405 |
$124K |
| D3320 |
|
326 |
255 |
$119K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
231 |
205 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,562 |
697 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
665 |
346 |
$77K |
| D2954 |
|
548 |
366 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,278 |
5,228 |
$51K |
| D2160 |
|
556 |
374 |
$44K |
| D1110 |
Prophylaxis - adult |
540 |
539 |
$41K |
| D4341 |
|
638 |
179 |
$40K |
| D8670 |
Periodic orthodontic treatment visit |
69 |
69 |
$20K |
| D9430 |
|
540 |
522 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,085 |
1,085 |
$13K |
| D4910 |
|
153 |
152 |
$11K |
| D0350 |
|
1,090 |
310 |
$10K |
| D0272 |
Bitewings - two radiographic images |
636 |
633 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
428 |
418 |
$5K |
| D3221 |
|
41 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
56 |
$2K |