| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
674 |
462 |
$321K |
| D2954 |
|
623 |
430 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
881 |
844 |
$58K |
| D4341 |
|
638 |
174 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
806 |
774 |
$38K |
| D1110 |
Prophylaxis - adult |
382 |
381 |
$33K |
| D3320 |
|
89 |
78 |
$33K |
| D9110 |
|
220 |
209 |
$14K |
| D4910 |
|
172 |
172 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
82 |
$11K |
| D1120 |
Prophylaxis - child |
204 |
184 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
126 |
126 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,833 |
396 |
$8K |
| D1206 |
Topical application of fluoride varnish |
412 |
412 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$6K |
| D0274 |
Bitewings - four radiographic images |
247 |
246 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
258 |
229 |
$4K |
| D9430 |
|
100 |
98 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
15 |
$2K |
| D4342 |
|
39 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$1K |