| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
426 |
360 |
$243K |
| D1110 |
Prophylaxis - adult |
3,393 |
3,360 |
$179K |
| D0140 |
Limited oral evaluation - problem focused |
2,617 |
2,519 |
$99K |
| D2954 |
|
533 |
445 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,246 |
3,213 |
$73K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
108 |
101 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
444 |
313 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
885 |
569 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,246 |
1,228 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,122 |
3,022 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,605 |
1,593 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
430 |
213 |
$34K |
| D9110 |
|
769 |
749 |
$27K |
| D2332 |
|
121 |
55 |
$13K |
| D0330 |
Panoramic radiographic image |
205 |
203 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
168 |
166 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
374 |
318 |
$4K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$1K |
| D0460 |
|
52 |
52 |
$0.00 |