| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,895 |
1,133 |
$1.91M |
| D2740 |
Crown - porcelain/ceramic |
1,778 |
509 |
$896K |
| D2954 |
|
3,195 |
1,835 |
$665K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,340 |
3,609 |
$609K |
| D1110 |
Prophylaxis - adult |
5,927 |
5,927 |
$336K |
| D3320 |
|
867 |
599 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
10,135 |
10,132 |
$287K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
618 |
530 |
$257K |
| D3310 |
|
718 |
310 |
$237K |
| D0210 |
Intraoral - complete series of radiographic images |
2,667 |
2,663 |
$119K |
| D5110 |
|
204 |
204 |
$114K |
| D1120 |
Prophylaxis - child |
2,141 |
2,141 |
$93K |
| D0330 |
Panoramic radiographic image |
2,268 |
2,268 |
$76K |
| D5120 |
|
106 |
106 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,443 |
3,414 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,464 |
2,464 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,682 |
1,635 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,000 |
2,000 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,946 |
1,933 |
$27K |
| D2140 |
|
188 |
147 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
83 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
50 |
$7K |
| D0274 |
Bitewings - four radiographic images |
204 |
204 |
$6K |