| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
996 |
685 |
$427K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,789 |
2,472 |
$292K |
| D1110 |
Prophylaxis - adult |
3,108 |
3,091 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,219 |
3,201 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,939 |
1,213 |
$141K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,104 |
1,005 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,023 |
5,004 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,928 |
1,926 |
$77K |
| D1120 |
Prophylaxis - child |
1,738 |
1,734 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
2,656 |
2,646 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
786 |
493 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,017 |
2,988 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,935 |
3,868 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,537 |
1,533 |
$15K |
| D1320 |
|
1,936 |
1,936 |
$14K |
| D2331 |
|
71 |
43 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
925 |
907 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
46 |
46 |
$3K |
| D0270 |
|
922 |
909 |
$2K |
| D9430 |
|
52 |
52 |
$1K |
| D0272 |
Bitewings - two radiographic images |
117 |
115 |
$775.00 |
| D0330 |
Panoramic radiographic image |
47 |
47 |
$735.00 |
| D0601 |
|
29 |
24 |
$20.00 |
| D1330 |
|
2,889 |
2,867 |
$0.00 |
| D9986 |
|
28 |
26 |
$0.00 |