| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
513 |
383 |
$241K |
| D0120 |
Periodic oral evaluation - established patient |
2,159 |
2,140 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,336 |
1,330 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,293 |
1,288 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,887 |
2,994 |
$59K |
| D2954 |
|
551 |
447 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
754 |
441 |
$50K |
| D1120 |
Prophylaxis - child |
1,326 |
1,315 |
$46K |
| D9430 |
|
933 |
918 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
237 |
127 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,090 |
2,072 |
$24K |
| D2160 |
|
275 |
152 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,855 |
1,835 |
$20K |
| D1110 |
Prophylaxis - adult |
168 |
168 |
$12K |
| D4910 |
|
161 |
160 |
$12K |
| D4341 |
|
144 |
40 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
545 |
537 |
$6K |
| D2931 |
|
29 |
28 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$280.80 |