| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
2,619 |
2,617 |
$202K |
| D1110 |
Prophylaxis - adult |
2,320 |
2,319 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
3,073 |
3,070 |
$188K |
| D5750 |
|
759 |
757 |
$148K |
| D5751 |
|
675 |
674 |
$132K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
251 |
146 |
$119K |
| D5410 |
|
2,430 |
2,290 |
$85K |
| D4341 |
|
1,274 |
406 |
$84K |
| D5411 |
|
2,219 |
2,117 |
$77K |
| D2330 |
|
910 |
514 |
$70K |
| D3320 |
|
127 |
114 |
$46K |
| D3221 |
|
710 |
557 |
$44K |
| D3310 |
|
146 |
111 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
597 |
597 |
$37K |
| D5422 |
|
1,019 |
873 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
740 |
739 |
$34K |
| D5421 |
|
942 |
773 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,348 |
2,347 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,509 |
1,969 |
$29K |
| D2740 |
Crown - porcelain/ceramic |
54 |
41 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
993 |
883 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,497 |
1,495 |
$17K |
| D4342 |
|
379 |
170 |
$14K |
| D5110 |
|
19 |
19 |
$12K |
| D5120 |
|
17 |
17 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
106 |
$9K |
| D5740 |
|
80 |
80 |
$8K |
| D5741 |
|
79 |
79 |
$7K |
| D5510 |
|
96 |
93 |
$7K |
| D9430 |
|
191 |
188 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
38 |
$3K |
| D5512 |
|
14 |
14 |
$980.00 |
| D1120 |
Prophylaxis - child |
24 |
24 |
$720.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$420.00 |