| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,628 |
1,080 |
$775K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
930 |
828 |
$431K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,044 |
1,878 |
$360K |
| D3320 |
|
935 |
794 |
$342K |
| D4341 |
|
4,507 |
1,312 |
$308K |
| D0120 |
Periodic oral evaluation - established patient |
4,865 |
4,840 |
$260K |
| D1110 |
Prophylaxis - adult |
3,098 |
3,083 |
$260K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,115 |
1,851 |
$248K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,583 |
3,570 |
$226K |
| D5750 |
|
1,072 |
1,065 |
$208K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,724 |
1,633 |
$183K |
| D5751 |
|
879 |
877 |
$170K |
| D3310 |
|
418 |
318 |
$126K |
| D2954 |
|
1,113 |
795 |
$117K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,395 |
4,953 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
3,871 |
3,825 |
$46K |
| D4342 |
|
1,056 |
383 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,461 |
3,444 |
$41K |
| D2952 |
|
283 |
203 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
160 |
$22K |
| D2394 |
|
259 |
197 |
$22K |
| D5110 |
|
24 |
24 |
$15K |
| D2331 |
|
175 |
138 |
$14K |
| D5850 |
|
166 |
166 |
$12K |
| D1120 |
Prophylaxis - child |
233 |
233 |
$10K |
| D5851 |
|
105 |
105 |
$7K |
| D2920 |
|
107 |
106 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
52 |
$4K |
| D0350 |
|
303 |
200 |
$3K |
| D5761 |
|
12 |
12 |
$2K |
| D6930 |
|
24 |
24 |
$2K |
| D2332 |
|
17 |
15 |
$2K |
| D5650 |
|
14 |
13 |
$1K |