| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
675 |
428 |
$318K |
| D1110 |
Prophylaxis - adult |
1,492 |
1,488 |
$133K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,680 |
900 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
1,482 |
1,476 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,689 |
1,679 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
887 |
490 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,417 |
1,407 |
$67K |
| D1120 |
Prophylaxis - child |
1,247 |
1,242 |
$58K |
| D2954 |
|
488 |
328 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,782 |
2,773 |
$39K |
| D2160 |
|
306 |
218 |
$24K |
| D1351 |
Sealant - per tooth |
486 |
124 |
$18K |
| D0274 |
Bitewings - four radiographic images |
821 |
820 |
$18K |
| D0350 |
|
1,454 |
698 |
$15K |
| D9430 |
|
271 |
271 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
544 |
544 |
$6K |
| D3320 |
|
15 |
13 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
307 |
305 |
$4K |
| D4341 |
|
52 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
277 |
$3K |
| D2140 |
|
17 |
14 |
$928.20 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
13 |
$806.40 |