| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
766 |
575 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
4,264 |
4,250 |
$222K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,237 |
1,605 |
$215K |
| D1110 |
Prophylaxis - adult |
2,517 |
2,499 |
$208K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,562 |
765 |
$184K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
371 |
332 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,383 |
7,115 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,871 |
1,862 |
$114K |
| D0274 |
Bitewings - four radiographic images |
5,087 |
5,053 |
$101K |
| D1120 |
Prophylaxis - child |
2,703 |
2,690 |
$93K |
| D9430 |
|
2,887 |
2,864 |
$91K |
| D2160 |
|
960 |
575 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,670 |
5,636 |
$68K |
| D2954 |
|
639 |
510 |
$67K |
| D4341 |
|
801 |
294 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,039 |
1,034 |
$48K |
| D1351 |
Sealant - per tooth |
1,833 |
561 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
526 |
232 |
$30K |
| D2140 |
|
345 |
237 |
$19K |
| D3320 |
|
43 |
38 |
$16K |
| D0330 |
Panoramic radiographic image |
626 |
622 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
795 |
788 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
22 |
12 |
$5K |
| D2330 |
|
56 |
24 |
$4K |
| D4910 |
|
50 |
50 |
$4K |
| D4342 |
|
23 |
13 |
$945.00 |
| D9993 |
|
14 |
14 |
$845.00 |
| D1310 |
|
14 |
14 |
$598.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$324.00 |