| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
495 |
302 |
$235K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,463 |
1,457 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
710 |
430 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
1,512 |
1,502 |
$82K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
165 |
151 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,582 |
1,570 |
$72K |
| D1110 |
Prophylaxis - adult |
567 |
566 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,087 |
1,801 |
$46K |
| D2954 |
|
392 |
255 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
341 |
205 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,584 |
1,574 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,486 |
1,432 |
$17K |
| D1120 |
Prophylaxis - child |
396 |
395 |
$15K |
| D9430 |
|
441 |
428 |
$13K |
| D0272 |
Bitewings - two radiographic images |
943 |
941 |
$11K |
| D2140 |
|
152 |
80 |
$8K |
| D0350 |
|
817 |
372 |
$8K |
| D1320 |
|
418 |
417 |
$6K |
| D4910 |
|
53 |
53 |
$4K |
| D1310 |
|
15 |
15 |
$0.00 |