| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
664 |
490 |
$330K |
| D4341 |
|
3,484 |
930 |
$262K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,432 |
1,432 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,236 |
3,221 |
$178K |
| D2330 |
|
2,298 |
1,089 |
$177K |
| D1110 |
Prophylaxis - adult |
2,231 |
2,223 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,235 |
577 |
$159K |
| D4910 |
|
1,838 |
1,835 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,162 |
2,157 |
$111K |
| D9110 |
|
1,472 |
1,424 |
$93K |
| D2331 |
|
967 |
414 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
1,919 |
1,918 |
$75K |
| D9430 |
|
2,123 |
2,065 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
3,155 |
3,000 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
597 |
274 |
$40K |
| D2950 |
|
316 |
243 |
$39K |
| D5640 |
|
549 |
157 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,443 |
1,437 |
$32K |
| D2954 |
|
293 |
243 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
68 |
64 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,038 |
2,034 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,859 |
2,970 |
$25K |
| D1120 |
Prophylaxis - child |
625 |
623 |
$19K |
| D5850 |
|
193 |
180 |
$14K |
| D5851 |
|
135 |
124 |
$10K |
| D1206 |
Topical application of fluoride varnish |
750 |
748 |
$7K |
| D5630 |
|
24 |
17 |
$3K |
| D5520 |
|
44 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
15 |
$3K |
| D2160 |
|
19 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$591.50 |
| D5422 |
|
12 |
12 |
$395.00 |