| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,192 |
910 |
$564K |
| D0120 |
Periodic oral evaluation - established patient |
1,225 |
1,207 |
$88K |
| D2954 |
|
809 |
661 |
$84K |
| D1110 |
Prophylaxis - adult |
891 |
880 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
777 |
483 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
647 |
$41K |
| D1120 |
Prophylaxis - child |
695 |
683 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
254 |
190 |
$29K |
| D3310 |
|
93 |
69 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
569 |
557 |
$27K |
| D2160 |
|
303 |
211 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,739 |
1,108 |
$15K |
| D1206 |
Topical application of fluoride varnish |
829 |
828 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
29 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,133 |
1,103 |
$13K |
| D4910 |
|
180 |
177 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
116 |
$13K |
| D0272 |
Bitewings - two radiographic images |
969 |
952 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
204 |
93 |
$11K |
| D3320 |
|
30 |
27 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
86 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
703 |
681 |
$10K |
| D2140 |
|
131 |
88 |
$7K |
| D2330 |
|
83 |
30 |
$6K |
| D4341 |
|
89 |
27 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
50 |
$5K |
| D1351 |
Sealant - per tooth |
124 |
29 |
$4K |
| D2931 |
|
35 |
33 |
$4K |
| D3221 |
|
28 |
26 |
$2K |
| D9430 |
|
12 |
12 |
$384.00 |