| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,384 |
928 |
$658K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,836 |
2,842 |
$458K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,900 |
5,888 |
$370K |
| D1110 |
Prophylaxis - adult |
4,442 |
4,422 |
$352K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,889 |
2,395 |
$319K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
644 |
599 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
5,461 |
5,453 |
$274K |
| D4341 |
|
3,657 |
1,010 |
$250K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,087 |
1,302 |
$243K |
| D0210 |
Intraoral - complete series of radiographic images |
3,913 |
3,901 |
$184K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,334 |
8,318 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,656 |
943 |
$148K |
| D0274 |
Bitewings - four radiographic images |
5,629 |
5,611 |
$119K |
| D3320 |
|
283 |
251 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,255 |
822 |
$100K |
| D2330 |
|
1,263 |
327 |
$99K |
| D1120 |
Prophylaxis - child |
2,724 |
2,718 |
$96K |
| D9430 |
|
3,026 |
2,817 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,212 |
7,188 |
$82K |
| D4910 |
|
819 |
819 |
$62K |
| D2954 |
|
428 |
320 |
$45K |
| D4342 |
|
686 |
236 |
$29K |
| D3310 |
|
65 |
40 |
$20K |
| D0330 |
Panoramic radiographic image |
228 |
227 |
$6K |
| D1351 |
Sealant - per tooth |
271 |
75 |
$6K |
| D0272 |
Bitewings - two radiographic images |
489 |
489 |
$6K |
| D5750 |
|
29 |
28 |
$5K |
| D5751 |
|
27 |
26 |
$5K |
| D9110 |
|
61 |
55 |
$4K |
| D2331 |
|
16 |
12 |
$1K |
| D0350 |
|
28 |
28 |
$0.00 |