| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
986 |
760 |
$469K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
850 |
761 |
$393K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,965 |
2,954 |
$195K |
| D2954 |
|
1,178 |
837 |
$124K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
486 |
295 |
$57K |
| D9430 |
|
1,636 |
1,470 |
$49K |
| D3320 |
|
123 |
106 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
588 |
330 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,122 |
2,895 |
$37K |
| D0330 |
Panoramic radiographic image |
841 |
835 |
$25K |
| D4910 |
|
316 |
316 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
496 |
496 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
206 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
33 |
14 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
202 |
202 |
$15K |
| D0274 |
Bitewings - four radiographic images |
681 |
681 |
$15K |
| D0350 |
|
700 |
601 |
$13K |
| D4341 |
|
114 |
31 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
564 |
551 |
$7K |
| D0272 |
Bitewings - two radiographic images |
385 |
383 |
$4K |
| D3310 |
|
14 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
51 |
$4K |
| D0270 |
|
574 |
572 |
$3K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$458.00 |