| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,535 |
952 |
$731K |
| D4341 |
|
4,652 |
1,427 |
$315K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
666 |
588 |
$308K |
| D0120 |
Periodic oral evaluation - established patient |
5,774 |
5,683 |
$301K |
| D1110 |
Prophylaxis - adult |
2,776 |
2,728 |
$221K |
| D2954 |
|
1,671 |
1,084 |
$175K |
| D1120 |
Prophylaxis - child |
4,254 |
4,183 |
$154K |
| D3320 |
|
413 |
328 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,356 |
2,307 |
$145K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,828 |
1,116 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,540 |
2,492 |
$115K |
| D0274 |
Bitewings - four radiographic images |
4,773 |
4,717 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,605 |
5,925 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
485 |
292 |
$56K |
| D2140 |
|
880 |
524 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,135 |
4,082 |
$42K |
| D4342 |
|
881 |
321 |
$36K |
| D4910 |
|
452 |
449 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
420 |
222 |
$23K |
| D3310 |
|
48 |
37 |
$14K |
| D2160 |
|
138 |
102 |
$11K |
| D1351 |
Sealant - per tooth |
297 |
66 |
$6K |
| D2931 |
|
33 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
66 |
66 |
$710.00 |