| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,841 |
1,260 |
$835K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,232 |
1,090 |
$792K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,758 |
5,374 |
$674K |
| D2954 |
|
4,867 |
3,470 |
$614K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,696 |
10,294 |
$436K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,809 |
2,753 |
$406K |
| D1110 |
Prophylaxis - adult |
11,648 |
11,182 |
$403K |
| D0210 |
Intraoral - complete series of radiographic images |
7,077 |
6,831 |
$400K |
| D0274 |
Bitewings - four radiographic images |
12,731 |
12,393 |
$393K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,644 |
17,121 |
$349K |
| D2791 |
|
846 |
753 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
13,632 |
13,282 |
$321K |
| D1120 |
Prophylaxis - child |
5,886 |
5,861 |
$259K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,720 |
1,231 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
5,884 |
5,498 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,913 |
7,440 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,403 |
1,024 |
$158K |
| D3320 |
|
248 |
188 |
$139K |
| D7250 |
|
740 |
398 |
$110K |
| D3310 |
|
175 |
104 |
$79K |
| D0330 |
Panoramic radiographic image |
1,513 |
1,396 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,176 |
740 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
3,961 |
3,690 |
$43K |
| D5213 |
|
65 |
57 |
$39K |
| D5110 |
|
48 |
41 |
$27K |
| D2332 |
|
202 |
130 |
$18K |
| D5120 |
|
15 |
13 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
92 |
$7K |
| D5214 |
|
14 |
12 |
$7K |
| D1351 |
Sealant - per tooth |
139 |
32 |
$5K |
| D2331 |
|
55 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
110 |
109 |
$3K |
| D2330 |
|
35 |
25 |
$2K |
| D2335 |
|
14 |
12 |
$2K |
| D2160 |
|
15 |
12 |
$979.75 |
| D9310 |
|
46 |
46 |
$842.52 |