| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,477 |
2,890 |
$431K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
810 |
680 |
$374K |
| D2791 |
|
675 |
469 |
$321K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,409 |
1,218 |
$280K |
| D2140 |
|
4,982 |
2,315 |
$267K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,551 |
3,527 |
$224K |
| D2954 |
|
1,840 |
1,166 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
3,324 |
3,298 |
$186K |
| D2160 |
|
2,106 |
1,242 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,974 |
6,903 |
$159K |
| D1110 |
Prophylaxis - adult |
1,735 |
1,712 |
$142K |
| D0274 |
Bitewings - four radiographic images |
6,676 |
6,626 |
$135K |
| D3320 |
|
336 |
256 |
$122K |
| D1120 |
Prophylaxis - child |
1,786 |
1,770 |
$69K |
| D2931 |
|
359 |
257 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,624 |
3,587 |
$44K |
| D9430 |
|
1,273 |
1,224 |
$40K |
| D4341 |
|
454 |
131 |
$32K |
| D3310 |
|
98 |
52 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,520 |
1,468 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
35 |
24 |
$17K |
| D2161 |
|
175 |
139 |
$15K |
| D1320 |
|
787 |
784 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
85 |
$9K |
| D2330 |
|
124 |
68 |
$9K |
| D1351 |
Sealant - per tooth |
141 |
45 |
$3K |
| D4342 |
|
36 |
14 |
$2K |
| D0350 |
|
92 |
45 |
$1K |
| D1330 |
|
995 |
994 |
$0.00 |