| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,344 |
1,604 |
$1.11M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
667 |
590 |
$309K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,735 |
3,684 |
$246K |
| D2954 |
|
2,176 |
1,501 |
$228K |
| D3320 |
|
512 |
407 |
$187K |
| D1110 |
Prophylaxis - adult |
1,993 |
1,961 |
$174K |
| D0210 |
Intraoral - complete series of radiographic images |
3,547 |
3,510 |
$167K |
| D4341 |
|
2,283 |
620 |
$159K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,139 |
385 |
$133K |
| D4910 |
|
1,062 |
1,026 |
$82K |
| D2140 |
|
1,498 |
594 |
$81K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,205 |
613 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
783 |
781 |
$69K |
| D0330 |
Panoramic radiographic image |
1,810 |
1,784 |
$54K |
| D3310 |
|
173 |
101 |
$52K |
| D4342 |
|
1,083 |
329 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,832 |
2,767 |
$42K |
| D1120 |
Prophylaxis - child |
760 |
755 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,775 |
1,118 |
$23K |
| D9430 |
|
701 |
613 |
$22K |
| D1320 |
|
1,261 |
1,261 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
40 |
26 |
$19K |
| D0274 |
Bitewings - four radiographic images |
702 |
699 |
$15K |
| D0350 |
|
1,563 |
719 |
$14K |
| D1351 |
Sealant - per tooth |
305 |
66 |
$12K |
| D2160 |
|
59 |
40 |
$5K |
| D2330 |
|
51 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |
| D0270 |
|
30 |
15 |
$120.00 |