| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,245 |
5,211 |
$323K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
674 |
480 |
$319K |
| D0120 |
Periodic oral evaluation - established patient |
5,604 |
5,553 |
$282K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,012 |
1,104 |
$226K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,960 |
1,415 |
$192K |
| D1120 |
Prophylaxis - child |
5,142 |
5,091 |
$181K |
| D4341 |
|
2,619 |
739 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
3,984 |
3,964 |
$177K |
| D1110 |
Prophylaxis - adult |
2,187 |
2,175 |
$169K |
| D0350 |
|
18,095 |
4,891 |
$158K |
| D9430 |
|
4,987 |
4,215 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,203 |
8,847 |
$106K |
| D1351 |
Sealant - per tooth |
4,020 |
1,082 |
$100K |
| D4910 |
|
1,341 |
1,330 |
$94K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
190 |
181 |
$88K |
| D0274 |
Bitewings - four radiographic images |
4,461 |
4,434 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,046 |
5,006 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
824 |
425 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
800 |
449 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
722 |
352 |
$40K |
| D2140 |
|
622 |
377 |
$33K |
| D2954 |
|
256 |
208 |
$26K |
| D2330 |
|
362 |
201 |
$25K |
| D2160 |
|
317 |
213 |
$24K |
| D9110 |
|
384 |
345 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,715 |
1,700 |
$19K |
| D0330 |
Panoramic radiographic image |
334 |
333 |
$10K |
| D3320 |
|
12 |
12 |
$4K |
| D4342 |
|
91 |
28 |
$4K |
| D3221 |
|
36 |
28 |
$2K |
| D1320 |
|
118 |
118 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
51 |
$588.00 |