| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,799 |
2,377 |
$362K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
405 |
215 |
$187K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,607 |
2,590 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
2,692 |
2,667 |
$157K |
| D1110 |
Prophylaxis - adult |
1,678 |
1,659 |
$121K |
| D1120 |
Prophylaxis - child |
3,445 |
3,416 |
$118K |
| D0350 |
|
10,866 |
3,400 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
2,221 |
2,190 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,570 |
4,098 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
620 |
222 |
$72K |
| D4341 |
|
994 |
284 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
966 |
541 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,226 |
5,178 |
$56K |
| D1351 |
Sealant - per tooth |
2,307 |
649 |
$50K |
| D2140 |
|
768 |
308 |
$41K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
89 |
74 |
$41K |
| D2954 |
|
338 |
176 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,719 |
2,697 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
431 |
219 |
$29K |
| D4910 |
|
363 |
360 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
421 |
199 |
$24K |
| D2330 |
|
312 |
151 |
$22K |
| D3320 |
|
58 |
42 |
$21K |
| D0330 |
Panoramic radiographic image |
612 |
606 |
$18K |
| D2160 |
|
118 |
65 |
$9K |
| D2332 |
|
32 |
12 |
$3K |
| D1320 |
|
191 |
191 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D2161 |
|
20 |
14 |
$2K |
| D4342 |
|
30 |
13 |
$1K |
| D9910 |
|
18 |
18 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$156.00 |
| D1310 |
|
103 |
103 |
$0.00 |
| D0603 |
|
103 |
103 |
$0.00 |
| D1330 |
|
82 |
82 |
$0.00 |
| D9993 |
|
103 |
103 |
$0.00 |