| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,208 |
901 |
$574K |
| D0120 |
Periodic oral evaluation - established patient |
6,062 |
6,044 |
$325K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,789 |
2,076 |
$253K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51,751 |
9,323 |
$210K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
453 |
412 |
$209K |
| D1110 |
Prophylaxis - adult |
2,354 |
2,341 |
$198K |
| D1120 |
Prophylaxis - child |
4,974 |
4,961 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,929 |
2,923 |
$183K |
| D1351 |
Sealant - per tooth |
6,010 |
1,455 |
$158K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,153 |
704 |
$135K |
| D2954 |
|
1,218 |
911 |
$128K |
| D4910 |
|
1,138 |
1,132 |
$88K |
| D0272 |
Bitewings - two radiographic images |
6,293 |
6,275 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,409 |
5,395 |
$62K |
| D4341 |
|
792 |
218 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,939 |
1,934 |
$41K |
| D3320 |
|
96 |
86 |
$35K |
| D9430 |
|
1,034 |
1,015 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
539 |
320 |
$31K |
| D0330 |
Panoramic radiographic image |
771 |
771 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,603 |
1,577 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
169 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
24 |
$3K |
| D1320 |
|
159 |
159 |
$2K |
| D0350 |
|
241 |
152 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
24 |
$2K |