| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
953 |
637 |
$452K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,684 |
739 |
$133K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
258 |
216 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,483 |
1,474 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,411 |
768 |
$94K |
| D1110 |
Prophylaxis - adult |
1,041 |
1,036 |
$93K |
| D2954 |
|
864 |
590 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
834 |
830 |
$68K |
| D4910 |
|
856 |
850 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,143 |
1,136 |
$54K |
| D0350 |
|
5,380 |
1,216 |
$52K |
| D1120 |
Prophylaxis - child |
821 |
814 |
$43K |
| D4341 |
|
527 |
138 |
$37K |
| D2394 |
|
416 |
301 |
$35K |
| D9430 |
|
1,052 |
998 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,866 |
1,856 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
439 |
216 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
998 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,626 |
1,498 |
$11K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
31 |
$396.00 |