| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,525 |
913 |
$723K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,795 |
2,832 |
$320K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
643 |
588 |
$297K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,496 |
1,285 |
$294K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,403 |
3,394 |
$225K |
| D2954 |
|
1,655 |
1,073 |
$173K |
| D2160 |
|
2,028 |
1,489 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
2,120 |
2,099 |
$159K |
| D4341 |
|
1,865 |
505 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,493 |
6,495 |
$126K |
| D2140 |
|
2,071 |
1,239 |
$112K |
| D1120 |
Prophylaxis - child |
2,501 |
2,477 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,814 |
880 |
$103K |
| D1110 |
Prophylaxis - adult |
794 |
789 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,345 |
3,311 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
831 |
830 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,249 |
3,226 |
$39K |
| D3320 |
|
87 |
70 |
$32K |
| D2931 |
|
236 |
186 |
$30K |
| D4910 |
|
384 |
381 |
$29K |
| D2332 |
|
308 |
176 |
$27K |
| D9430 |
|
804 |
797 |
$26K |
| D0350 |
|
2,339 |
1,216 |
$22K |
| D9110 |
|
345 |
329 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
288 |
163 |
$16K |
| D2330 |
|
177 |
108 |
$14K |
| D2335 |
|
109 |
67 |
$13K |
| D3310 |
|
34 |
25 |
$10K |
| D1351 |
Sealant - per tooth |
195 |
54 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
243 |
$3K |
| D0270 |
|
503 |
498 |
$2K |
| D4342 |
|
52 |
16 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D3221 |
|
17 |
17 |
$1K |