| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
659 |
384 |
$313K |
| D1110 |
Prophylaxis - adult |
2,729 |
2,716 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
2,711 |
2,698 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,836 |
1,825 |
$115K |
| D4341 |
|
1,170 |
321 |
$80K |
| D4910 |
|
1,028 |
1,023 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,132 |
4,191 |
$78K |
| D9430 |
|
2,334 |
2,272 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
1,399 |
1,391 |
$65K |
| D0274 |
Bitewings - four radiographic images |
3,012 |
3,002 |
$62K |
| D2952 |
|
537 |
321 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,187 |
4,166 |
$53K |
| D1120 |
Prophylaxis - child |
1,444 |
1,443 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
221 |
101 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,194 |
1,156 |
$14K |
| D2160 |
|
123 |
69 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
37 |
$5K |
| D1351 |
Sealant - per tooth |
188 |
36 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
26 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
24 |
$3K |
| D4342 |
|
44 |
13 |
$2K |
| D9110 |
|
12 |
12 |
$756.00 |