| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,229 |
4,209 |
$354K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,225 |
2,536 |
$281K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,135 |
1,048 |
$248K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,512 |
3,503 |
$218K |
| D0210 |
Intraoral - complete series of radiographic images |
3,793 |
3,780 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
3,082 |
3,062 |
$170K |
| D2160 |
|
2,129 |
1,483 |
$168K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
234 |
166 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,912 |
5,890 |
$76K |
| D4341 |
|
1,044 |
292 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,956 |
3,131 |
$70K |
| D1120 |
Prophylaxis - child |
1,843 |
1,836 |
$65K |
| D9430 |
|
1,836 |
1,753 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,298 |
2,287 |
$48K |
| D4910 |
|
615 |
607 |
$47K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
84 |
67 |
$39K |
| D2954 |
|
239 |
172 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
599 |
$7K |
| D0350 |
|
564 |
382 |
$5K |
| D2330 |
|
18 |
12 |
$1K |
| D2140 |
|
16 |
12 |
$873.60 |
| D0270 |
|
148 |
145 |
$708.75 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$164.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |