| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
770 |
564 |
$394K |
| D1110 |
Prophylaxis - adult |
4,352 |
4,350 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,876 |
1,186 |
$120K |
| D2954 |
|
668 |
518 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,486 |
4,486 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,851 |
2,849 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,688 |
2,687 |
$57K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
125 |
109 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
5,022 |
5,009 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,792 |
1,792 |
$43K |
| D4341 |
|
832 |
385 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
2,947 |
2,934 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
959 |
597 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,175 |
1,173 |
$13K |
| D2331 |
|
154 |
109 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
573 |
566 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
81 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
140 |
98 |
$6K |
| D0270 |
|
398 |
398 |
$4K |
| D3320 |
|
13 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
69 |
69 |
$2K |