| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
596 |
362 |
$283K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,092 |
2,090 |
$138K |
| D4341 |
|
1,980 |
517 |
$136K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
278 |
222 |
$129K |
| D1110 |
Prophylaxis - adult |
1,042 |
1,042 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,673 |
1,672 |
$80K |
| D3320 |
|
215 |
161 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
947 |
441 |
$63K |
| D2954 |
|
553 |
340 |
$58K |
| D3310 |
|
189 |
115 |
$57K |
| D1120 |
Prophylaxis - child |
713 |
713 |
$36K |
| D2140 |
|
627 |
319 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
270 |
167 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,548 |
683 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,030 |
1,030 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
232 |
99 |
$13K |
| D1206 |
Topical application of fluoride varnish |
769 |
769 |
$12K |
| D4910 |
|
127 |
127 |
$10K |
| D1351 |
Sealant - per tooth |
211 |
44 |
$8K |
| D0350 |
|
1,089 |
463 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
66 |
66 |
$5K |
| D0272 |
Bitewings - two radiographic images |
369 |
367 |
$4K |
| D4342 |
|
43 |
12 |
$2K |
| D2160 |
|
22 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$2K |
| D0274 |
Bitewings - four radiographic images |
47 |
47 |
$1K |
| D1310 |
|
12 |
12 |
$552.00 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
42 |
$504.00 |