| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,809 |
1,176 |
$854K |
| D1110 |
Prophylaxis - adult |
6,867 |
6,826 |
$553K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,143 |
945 |
$517K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,069 |
8,029 |
$509K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,181 |
1,804 |
$348K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,525 |
7,373 |
$207K |
| D2952 |
|
1,657 |
1,068 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
2,932 |
2,921 |
$162K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,637 |
937 |
$149K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,216 |
8,170 |
$106K |
| D9110 |
|
1,845 |
1,690 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
8,697 |
8,556 |
$103K |
| D3320 |
|
268 |
207 |
$97K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
720 |
576 |
$47K |
| D1120 |
Prophylaxis - child |
809 |
803 |
$29K |
| D5750 |
|
149 |
149 |
$28K |
| D9430 |
|
482 |
475 |
$15K |
| D3310 |
|
37 |
24 |
$11K |
| D5751 |
|
52 |
52 |
$10K |
| D2160 |
|
110 |
101 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
184 |
$9K |
| D2140 |
|
92 |
66 |
$5K |
| D0274 |
Bitewings - four radiographic images |
171 |
171 |
$3K |
| D5410 |
|
71 |
71 |
$2K |
| D5411 |
|
31 |
31 |
$1K |
| D2920 |
|
12 |
12 |
$462.00 |
| D0270 |
|
13 |
12 |
$60.00 |