| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,280 |
3,263 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,140 |
970 |
$143K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,150 |
414 |
$134K |
| D1351 |
Sealant - per tooth |
3,828 |
766 |
$121K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
242 |
184 |
$115K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,506 |
4,550 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
1,394 |
1,388 |
$104K |
| D1120 |
Prophylaxis - child |
2,094 |
2,084 |
$96K |
| D2140 |
|
1,346 |
622 |
$72K |
| D1110 |
Prophylaxis - adult |
805 |
800 |
$70K |
| D9430 |
|
2,064 |
1,817 |
$66K |
| D0350 |
|
5,618 |
1,563 |
$53K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
110 |
102 |
$50K |
| D0272 |
Bitewings - two radiographic images |
4,069 |
4,049 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
95 |
69 |
$45K |
| D2954 |
|
404 |
305 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,449 |
2,440 |
$35K |
| D4341 |
|
342 |
110 |
$24K |
| D4910 |
|
193 |
193 |
$15K |
| D0330 |
Panoramic radiographic image |
428 |
428 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
227 |
64 |
$12K |
| D1320 |
|
522 |
516 |
$8K |
| D2160 |
|
88 |
53 |
$7K |
| D2332 |
|
75 |
15 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
12 |
$3K |
| D2330 |
|
32 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
108 |
108 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
152 |
151 |
$2K |
| D1310 |
|
12 |
12 |
$552.00 |