| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,036 |
668 |
$493K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,115 |
1,095 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,507 |
2,504 |
$161K |
| D1110 |
Prophylaxis - adult |
1,735 |
1,732 |
$154K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,123 |
633 |
$132K |
| D4341 |
|
1,873 |
556 |
$131K |
| D0210 |
Intraoral - complete series of radiographic images |
2,303 |
2,300 |
$109K |
| D4910 |
|
1,250 |
1,243 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,733 |
808 |
$94K |
| D2394 |
|
965 |
614 |
$81K |
| D9430 |
|
2,509 |
2,374 |
$80K |
| D2954 |
|
721 |
468 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,035 |
1,030 |
$75K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
141 |
124 |
$65K |
| D3320 |
|
174 |
140 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
756 |
450 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,811 |
2,805 |
$39K |
| D1120 |
Prophylaxis - child |
799 |
796 |
$35K |
| D0350 |
|
1,742 |
1,383 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,410 |
1,403 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,350 |
3,307 |
$28K |
| D2160 |
|
337 |
179 |
$27K |
| D3310 |
|
55 |
24 |
$17K |
| D2140 |
|
295 |
155 |
$16K |
| D4342 |
|
342 |
142 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,159 |
1,093 |
$14K |
| D2330 |
|
169 |
114 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
162 |
109 |
$11K |
| D1351 |
Sealant - per tooth |
85 |
25 |
$3K |
| D2161 |
|
33 |
20 |
$3K |
| D2332 |
|
24 |
16 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
15 |
$1K |
| D9910 |
|
40 |
15 |
$1K |
| D1320 |
|
14 |
14 |
$205.00 |
| D0270 |
|
15 |
14 |
$75.00 |