| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
616 |
364 |
$292K |
| D1110 |
Prophylaxis - adult |
2,024 |
2,019 |
$174K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,319 |
842 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,028 |
2,027 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,852 |
3,994 |
$88K |
| D4341 |
|
1,237 |
340 |
$86K |
| D2160 |
|
1,020 |
542 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
695 |
359 |
$80K |
| D9430 |
|
1,257 |
1,205 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,338 |
3,331 |
$40K |
| D1120 |
Prophylaxis - child |
824 |
824 |
$34K |
| D2954 |
|
321 |
219 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
421 |
421 |
$29K |
| D2140 |
|
261 |
122 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
64 |
$9K |
| D0350 |
|
735 |
271 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D2161 |
|
34 |
28 |
$3K |
| D4342 |
|
49 |
16 |
$2K |
| D1999 |
|
16 |
16 |
$0.00 |