| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,357 |
1,442 |
$1.12M |
| D3320 |
|
1,322 |
1,051 |
$481K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,012 |
7,002 |
$429K |
| D0120 |
Periodic oral evaluation - established patient |
5,826 |
5,804 |
$303K |
| D3310 |
|
987 |
545 |
$296K |
| D1110 |
Prophylaxis - adult |
3,570 |
3,560 |
$293K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
628 |
573 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65,600 |
14,633 |
$269K |
| D2954 |
|
2,423 |
1,491 |
$252K |
| D0274 |
Bitewings - four radiographic images |
10,474 |
10,447 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,037 |
1,997 |
$203K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,657 |
1,174 |
$196K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,386 |
1,708 |
$159K |
| D1120 |
Prophylaxis - child |
3,847 |
3,838 |
$142K |
| D2330 |
|
1,467 |
913 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
6,668 |
5,915 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,228 |
846 |
$70K |
| D2160 |
|
865 |
666 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
508 |
440 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
368 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,110 |
2,105 |
$24K |
| D2140 |
|
245 |
176 |
$13K |
| D2332 |
|
82 |
53 |
$7K |
| D2331 |
|
30 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$1K |
| D9430 |
|
24 |
24 |
$768.00 |