| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
521 |
309 |
$248K |
| D2330 |
|
2,504 |
551 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
749 |
747 |
$49K |
| D2160 |
|
560 |
300 |
$44K |
| D2952 |
|
417 |
255 |
$44K |
| D4341 |
|
573 |
156 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
566 |
305 |
$38K |
| D1120 |
Prophylaxis - child |
633 |
633 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,077 |
1,424 |
$30K |
| D1110 |
Prophylaxis - adult |
357 |
356 |
$30K |
| D4910 |
|
361 |
360 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
358 |
358 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
495 |
495 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,274 |
1,272 |
$21K |
| D2161 |
|
233 |
88 |
$19K |
| D0350 |
|
884 |
605 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
438 |
380 |
$17K |
| D2332 |
|
194 |
99 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,254 |
1,055 |
$15K |
| D9430 |
|
373 |
322 |
$12K |
| D1351 |
Sealant - per tooth |
284 |
68 |
$11K |
| D1320 |
|
637 |
637 |
$10K |
| D2335 |
|
61 |
37 |
$7K |
| D0272 |
Bitewings - two radiographic images |
462 |
462 |
$6K |
| D1310 |
|
109 |
109 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
29 |
$4K |
| D7510 |
|
56 |
53 |
$3K |
| D4342 |
|
47 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
13 |
$2K |
| D0603 |
|
109 |
109 |
$2K |
| D2140 |
|
22 |
12 |
$1K |