| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,323 |
908 |
$629K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,368 |
5,350 |
$351K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
430 |
401 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
2,992 |
2,978 |
$142K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,103 |
525 |
$130K |
| D9430 |
|
3,631 |
3,395 |
$115K |
| D2954 |
|
1,043 |
794 |
$109K |
| D1110 |
Prophylaxis - adult |
975 |
969 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,461 |
4,147 |
$79K |
| D2140 |
|
1,343 |
618 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,179 |
1,177 |
$69K |
| D1120 |
Prophylaxis - child |
1,631 |
1,627 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
765 |
448 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,922 |
1,921 |
$40K |
| D3320 |
|
58 |
52 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,472 |
1,469 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,445 |
1,436 |
$18K |
| D0350 |
|
1,385 |
755 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,014 |
979 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
36 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
145 |
136 |
$6K |
| D1320 |
|
323 |
322 |
$5K |
| D0272 |
Bitewings - two radiographic images |
339 |
339 |
$4K |
| D0270 |
|
470 |
434 |
$2K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$2K |
| D9993 |
|
30 |
30 |
$2K |
| D1310 |
|
30 |
30 |
$1K |