| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
399 |
280 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,602 |
2,592 |
$166K |
| D2740 |
Crown - porcelain/ceramic |
288 |
205 |
$137K |
| D0210 |
Intraoral - complete series of radiographic images |
2,388 |
2,378 |
$111K |
| D4341 |
|
1,426 |
561 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
777 |
416 |
$92K |
| D9430 |
|
2,529 |
2,326 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,314 |
1,309 |
$77K |
| D1110 |
Prophylaxis - adult |
726 |
723 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
944 |
536 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
894 |
527 |
$60K |
| D2160 |
|
689 |
403 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
676 |
385 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,720 |
2,704 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
668 |
231 |
$38K |
| D1320 |
|
2,529 |
2,517 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,254 |
1,251 |
$25K |
| D2954 |
|
230 |
180 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,739 |
1,733 |
$23K |
| D1120 |
Prophylaxis - child |
548 |
548 |
$21K |
| D3221 |
|
258 |
220 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
266 |
170 |
$14K |
| D4342 |
|
234 |
100 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
706 |
692 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
16 |
$7K |
| D3320 |
|
13 |
13 |
$5K |
| D4910 |
|
27 |
27 |
$2K |
| D2140 |
|
17 |
13 |
$928.20 |