| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
338 |
202 |
$160K |
| D9430 |
|
2,041 |
2,026 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,048 |
1,040 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,386 |
1,373 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,033 |
1,029 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
375 |
209 |
$42K |
| D0330 |
Panoramic radiographic image |
1,420 |
1,404 |
$41K |
| D2952 |
|
228 |
151 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,930 |
1,331 |
$21K |
| D4341 |
|
227 |
69 |
$16K |
| D1120 |
Prophylaxis - child |
467 |
456 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
556 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
353 |
347 |
$4K |
| D2140 |
|
71 |
28 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
14 |
$3K |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$3K |