| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
494 |
341 |
$235K |
| D1110 |
Prophylaxis - adult |
1,687 |
1,683 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,093 |
2,083 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
1,882 |
1,874 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
1,703 |
1,695 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,014 |
2,938 |
$62K |
| D1120 |
Prophylaxis - child |
1,491 |
1,481 |
$61K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
795 |
468 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
404 |
187 |
$48K |
| D9430 |
|
1,232 |
1,144 |
$39K |
| D2954 |
|
336 |
233 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,604 |
1,597 |
$34K |
| D4910 |
|
381 |
375 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,932 |
1,783 |
$23K |
| D4341 |
|
267 |
79 |
$18K |
| D2160 |
|
203 |
143 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
24 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
680 |
671 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
36 |
$5K |
| D0350 |
|
495 |
243 |
$5K |
| D1351 |
Sealant - per tooth |
115 |
26 |
$4K |
| D2140 |
|
70 |
46 |
$4K |
| D0272 |
Bitewings - two radiographic images |
57 |
54 |
$684.00 |