| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,236 |
1,210 |
$681K |
| D2752 |
|
788 |
419 |
$253K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
610 |
474 |
$189K |
| D2950 |
|
3,238 |
1,865 |
$170K |
| D3320 |
|
670 |
482 |
$146K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,806 |
4,773 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
3,183 |
3,156 |
$75K |
| D1110 |
Prophylaxis - adult |
3,986 |
3,953 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
3,261 |
3,235 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
3,107 |
2,980 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,244 |
706 |
$47K |
| D3310 |
|
200 |
118 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
858 |
464 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
846 |
231 |
$29K |
| D1120 |
Prophylaxis - child |
1,268 |
1,260 |
$21K |
| D4341 |
|
532 |
203 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
535 |
270 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,452 |
2,418 |
$17K |
| D0274 |
Bitewings - four radiographic images |
2,351 |
2,327 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
4,196 |
3,952 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,498 |
2,662 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
342 |
70 |
$14K |
| D2394 |
|
216 |
128 |
$10K |
| D1351 |
Sealant - per tooth |
314 |
30 |
$6K |
| D0160 |
|
234 |
230 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
27 |
$618.00 |
| D0272 |
Bitewings - two radiographic images |
135 |
135 |
$616.25 |