| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,401 |
1,021 |
$667K |
| D1110 |
Prophylaxis - adult |
6,070 |
6,046 |
$504K |
| D0120 |
Periodic oral evaluation - established patient |
5,877 |
5,852 |
$334K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,894 |
3,881 |
$246K |
| D9430 |
|
5,755 |
5,217 |
$182K |
| D0274 |
Bitewings - four radiographic images |
7,208 |
7,181 |
$152K |
| D1351 |
Sealant - per tooth |
4,751 |
951 |
$125K |
| D1120 |
Prophylaxis - child |
3,330 |
3,313 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,389 |
9,348 |
$121K |
| D2954 |
|
903 |
722 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,068 |
6,328 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,060 |
665 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,283 |
4,021 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
746 |
631 |
$50K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
100 |
97 |
$46K |
| D3221 |
|
677 |
592 |
$42K |
| D3320 |
|
88 |
78 |
$32K |
| D4341 |
|
299 |
83 |
$21K |
| D2160 |
|
248 |
237 |
$20K |
| D2330 |
|
254 |
193 |
$19K |
| D3310 |
|
64 |
52 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,150 |
1,145 |
$13K |
| D2140 |
|
224 |
198 |
$12K |
| D9110 |
|
113 |
110 |
$7K |
| D2920 |
|
158 |
145 |
$6K |
| D4910 |
|
78 |
78 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
98 |
$5K |
| D5211 |
|
13 |
13 |
$5K |
| D9130 |
|
13 |
13 |
$0.00 |
| D1330 |
|
7,431 |
7,395 |
$0.00 |