| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,306 |
973 |
$621K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,050 |
1,674 |
$360K |
| D0120 |
Periodic oral evaluation - established patient |
6,205 |
6,193 |
$337K |
| D4341 |
|
4,956 |
1,390 |
$335K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,871 |
2,527 |
$326K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,637 |
4,626 |
$280K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
476 |
447 |
$221K |
| D4910 |
|
2,681 |
2,678 |
$205K |
| D1110 |
Prophylaxis - adult |
2,394 |
2,388 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
4,103 |
4,093 |
$191K |
| D1120 |
Prophylaxis - child |
4,811 |
4,799 |
$179K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,636 |
6,778 |
$154K |
| D2160 |
|
1,712 |
1,187 |
$136K |
| D9430 |
|
3,223 |
2,958 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,433 |
4,419 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,286 |
7,269 |
$89K |
| D2140 |
|
1,632 |
784 |
$88K |
| D3320 |
|
230 |
197 |
$84K |
| D2954 |
|
762 |
614 |
$80K |
| D1351 |
Sealant - per tooth |
3,120 |
774 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,166 |
528 |
$67K |
| D3310 |
|
115 |
80 |
$35K |
| D4342 |
|
804 |
269 |
$34K |
| D0350 |
|
2,758 |
1,072 |
$26K |
| D2161 |
|
184 |
156 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,196 |
1,196 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,045 |
1,038 |
$12K |
| D5130 |
|
12 |
12 |
$7K |
| D5211 |
|
14 |
14 |
$5K |
| D2330 |
|
32 |
16 |
$2K |
| D9110 |
|
25 |
24 |
$2K |