| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,018 |
799 |
$364K |
| D1110 |
Prophylaxis - adult |
7,326 |
7,325 |
$298K |
| D0120 |
Periodic oral evaluation - established patient |
9,716 |
9,714 |
$198K |
| D2791 |
|
622 |
610 |
$190K |
| D0274 |
Bitewings - four radiographic images |
9,169 |
9,169 |
$187K |
| D2954 |
|
1,821 |
1,683 |
$170K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
575 |
567 |
$144K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,101 |
1,768 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
10,096 |
10,091 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,669 |
1,442 |
$96K |
| D2752 |
|
215 |
199 |
$90K |
| D3320 |
|
369 |
354 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,594 |
1,253 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,411 |
9,411 |
$57K |
| D1120 |
Prophylaxis - child |
1,079 |
1,079 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,096 |
2,096 |
$23K |
| D9110 |
|
597 |
597 |
$11K |
| D2160 |
|
145 |
137 |
$9K |
| D2331 |
|
47 |
43 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$443.52 |