| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
645 |
487 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,055 |
3,044 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
30,883 |
6,033 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
1,117 |
1,116 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,176 |
670 |
$77K |
| D4341 |
|
952 |
268 |
$64K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
134 |
130 |
$62K |
| D9430 |
|
1,970 |
1,924 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,109 |
550 |
$59K |
| D1120 |
Prophylaxis - child |
1,200 |
1,191 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,674 |
2,667 |
$54K |
| D0340 |
|
918 |
914 |
$46K |
| D1351 |
Sealant - per tooth |
1,177 |
291 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
366 |
216 |
$41K |
| D1110 |
Prophylaxis - adult |
440 |
439 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,065 |
2,055 |
$32K |
| D0330 |
Panoramic radiographic image |
1,034 |
1,032 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,619 |
1,610 |
$19K |
| D2954 |
|
185 |
144 |
$19K |
| D4910 |
|
211 |
211 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
267 |
228 |
$10K |
| D0350 |
|
1,031 |
466 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
819 |
804 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
228 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
158 |
$7K |
| D1310 |
|
78 |
77 |
$3K |
| D1320 |
|
162 |
162 |
$3K |
| D9110 |
|
26 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D3221 |
|
16 |
12 |
$1K |
| D0603 |
|
77 |
76 |
$971.25 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$402.50 |
| D0270 |
|
25 |
25 |
$120.00 |
| D9993 |
|
31 |
31 |
$0.00 |