| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
266 |
185 |
$126K |
| D9430 |
|
3,639 |
3,449 |
$113K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
242 |
214 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,187 |
1,186 |
$78K |
| D7240 |
Removal of impacted tooth - completely bony |
323 |
140 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
474 |
283 |
$56K |
| D0330 |
Panoramic radiographic image |
1,432 |
1,431 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
72 |
51 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
636 |
634 |
$29K |
| D2954 |
|
256 |
183 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,836 |
1,759 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
41 |
$7K |
| D1120 |
Prophylaxis - child |
113 |
113 |
$5K |
| D7230 |
|
23 |
13 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
364 |
364 |
$4K |
| D0274 |
Bitewings - four radiographic images |
213 |
212 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
29 |
$3K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$1K |
| D0270 |
|
248 |
248 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
70 |
70 |
$891.00 |
| D1320 |
|
36 |
36 |
$615.00 |