| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,934 |
1,441 |
$1.39M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,603 |
1,293 |
$734K |
| D2954 |
|
4,479 |
2,456 |
$466K |
| D3320 |
|
899 |
673 |
$324K |
| D1110 |
Prophylaxis - adult |
3,281 |
3,271 |
$275K |
| D4341 |
|
3,622 |
988 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
4,032 |
4,026 |
$219K |
| D3310 |
|
718 |
366 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,319 |
3,301 |
$206K |
| D2931 |
|
1,417 |
990 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
3,690 |
3,677 |
$173K |
| D4910 |
|
2,200 |
2,194 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,079 |
5,120 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,651 |
390 |
$94K |
| D1120 |
Prophylaxis - child |
2,006 |
1,998 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,384 |
5,366 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
537 |
300 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,689 |
2,683 |
$56K |
| D9430 |
|
1,442 |
1,388 |
$45K |
| D0330 |
Panoramic radiographic image |
1,058 |
1,058 |
$30K |
| D1351 |
Sealant - per tooth |
1,268 |
286 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,369 |
2,323 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
323 |
190 |
$25K |
| D5750 |
|
112 |
111 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
154 |
$16K |
| D5850 |
|
166 |
136 |
$12K |
| D4342 |
|
173 |
67 |
$7K |
| D5751 |
|
24 |
24 |
$5K |
| D5851 |
|
45 |
36 |
$3K |
| D0272 |
Bitewings - two radiographic images |
100 |
100 |
$1K |