| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
882 |
503 |
$419K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,186 |
1,031 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
2,311 |
2,303 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,247 |
1,244 |
$78K |
| D1120 |
Prophylaxis - child |
1,910 |
1,904 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,851 |
3,383 |
$64K |
| D4341 |
|
884 |
241 |
$62K |
| D2954 |
|
569 |
359 |
$60K |
| D1110 |
Prophylaxis - adult |
562 |
562 |
$49K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
98 |
86 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,135 |
2,129 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
783 |
783 |
$37K |
| D2140 |
|
630 |
276 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
422 |
200 |
$24K |
| D9430 |
|
562 |
554 |
$18K |
| D2160 |
|
197 |
121 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,376 |
1,372 |
$14K |
| D0350 |
|
683 |
351 |
$6K |
| D0272 |
Bitewings - two radiographic images |
115 |
115 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
56 |
$672.00 |
| D0270 |
|
12 |
12 |
$60.00 |