| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,261 |
1,161 |
$1.12M |
| D1110 |
Prophylaxis - adult |
7,716 |
7,715 |
$433K |
| D0120 |
Periodic oral evaluation - established patient |
14,245 |
14,242 |
$395K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,568 |
2,463 |
$326K |
| D0272 |
Bitewings - two radiographic images |
12,633 |
12,632 |
$208K |
| D0330 |
Panoramic radiographic image |
5,419 |
5,418 |
$176K |
| D2954 |
|
601 |
571 |
$116K |
| D1120 |
Prophylaxis - child |
2,231 |
2,231 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,231 |
1,114 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
847 |
797 |
$86K |
| D3320 |
|
162 |
156 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,836 |
3,816 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,522 |
3,522 |
$49K |
| D1351 |
Sealant - per tooth |
322 |
266 |
$42K |
| D3310 |
|
73 |
70 |
$24K |
| D9243 |
|
74 |
74 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
443 |
443 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
939 |
933 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
808 |
808 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
508 |
508 |
$7K |
| D9239 |
|
85 |
85 |
$6K |
| D2330 |
|
26 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
16 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$1K |
| D9996 |
|
12 |
12 |
$150.72 |
| D1999 |
|
23 |
23 |
$0.00 |