| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
519 |
388 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
4,178 |
4,175 |
$226K |
| D2140 |
|
2,869 |
1,582 |
$156K |
| D1120 |
Prophylaxis - child |
3,590 |
3,576 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,621 |
7,025 |
$134K |
| D1110 |
Prophylaxis - adult |
1,376 |
1,374 |
$119K |
| D0274 |
Bitewings - four radiographic images |
5,043 |
5,040 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,647 |
1,646 |
$104K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
990 |
688 |
$66K |
| D0330 |
Panoramic radiographic image |
1,943 |
1,937 |
$58K |
| D9430 |
|
1,592 |
1,517 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,765 |
3,752 |
$45K |
| D0350 |
|
4,636 |
2,409 |
$45K |
| D2954 |
|
389 |
294 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
250 |
200 |
$30K |
| D4910 |
|
306 |
305 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,819 |
1,768 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
514 |
429 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
24 |
$13K |
| D1351 |
Sealant - per tooth |
405 |
143 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
66 |
$6K |
| D4341 |
|
99 |
26 |
$6K |
| D2940 |
|
43 |
39 |
$3K |
| D2160 |
|
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
82 |
82 |
$984.00 |
| D2330 |
|
16 |
12 |
$924.00 |
| D3221 |
|
13 |
12 |
$819.00 |