| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
966 |
613 |
$638K |
| D1110 |
Prophylaxis - adult |
5,832 |
5,831 |
$318K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,271 |
702 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,391 |
1,052 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
2,020 |
1,985 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,627 |
3,625 |
$98K |
| D2954 |
|
562 |
381 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,241 |
885 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,945 |
1,945 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,087 |
2,087 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,727 |
2,652 |
$36K |
| D9944 |
|
206 |
206 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
318 |
145 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
55 |
51 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
218 |
178 |
$24K |
| D0330 |
Panoramic radiographic image |
424 |
424 |
$18K |
| D3320 |
|
39 |
38 |
$15K |
| D2331 |
|
158 |
133 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
759 |
759 |
$11K |
| D2330 |
|
125 |
87 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
695 |
640 |
$7K |
| D0272 |
Bitewings - two radiographic images |
384 |
384 |
$7K |
| D1320 |
|
757 |
757 |
$6K |
| D2332 |
|
44 |
28 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
52 |
$771.20 |
| D9986 |
|
252 |
250 |
$0.00 |