| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
990 |
720 |
$542K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,485 |
1,884 |
$262K |
| D1110 |
Prophylaxis - adult |
5,760 |
5,715 |
$215K |
| D0140 |
Limited oral evaluation - problem focused |
3,618 |
3,418 |
$133K |
| D2335 |
|
1,462 |
993 |
$114K |
| D2950 |
|
1,507 |
1,188 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,301 |
4,280 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,893 |
1,876 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,040 |
4,014 |
$74K |
| D1120 |
Prophylaxis - child |
2,298 |
2,291 |
$71K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
107 |
100 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,255 |
2,246 |
$35K |
| D0272 |
Bitewings - two radiographic images |
4,321 |
4,304 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
689 |
542 |
$28K |
| D2140 |
|
658 |
510 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
5,909 |
5,411 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
247 |
152 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
284 |
216 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
222 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
143 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,816 |
2,380 |
$7K |
| D2160 |
|
14 |
12 |
$636.00 |