| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,138 |
601 |
$538K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,927 |
857 |
$227K |
| D4341 |
|
2,722 |
780 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
2,931 |
2,923 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,184 |
2,180 |
$135K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,784 |
933 |
$118K |
| D1110 |
Prophylaxis - adult |
1,285 |
1,277 |
$111K |
| D2952 |
|
858 |
472 |
$89K |
| D2160 |
|
946 |
615 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,539 |
1,536 |
$73K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
122 |
105 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,729 |
3,435 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,429 |
2,418 |
$51K |
| D1120 |
Prophylaxis - child |
1,195 |
1,194 |
$43K |
| D3320 |
|
64 |
51 |
$23K |
| D4342 |
|
442 |
160 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,015 |
1,014 |
$11K |
| D3310 |
|
36 |
25 |
$11K |
| D2332 |
|
126 |
82 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
50 |
$8K |
| D9430 |
|
109 |
108 |
$3K |
| D0350 |
|
270 |
132 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
78 |
78 |
$855.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$312.00 |