| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
697 |
530 |
$331K |
| D1110 |
Prophylaxis - adult |
2,447 |
2,437 |
$209K |
| D2952 |
|
939 |
693 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,832 |
4,168 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,376 |
915 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
833 |
618 |
$66K |
| D2740 |
Crown - porcelain/ceramic |
127 |
89 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,415 |
2,405 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
704 |
704 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,058 |
2,949 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
426 |
206 |
$24K |
| D2330 |
|
118 |
100 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
175 |
$8K |
| D4341 |
|
105 |
31 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D3320 |
|
16 |
14 |
$6K |
| D2160 |
|
73 |
58 |
$6K |
| D3310 |
|
16 |
14 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
68 |
52 |
$5K |
| D9110 |
|
66 |
63 |
$4K |
| D2331 |
|
38 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$928.20 |