| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
436 |
332 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
2,720 |
2,713 |
$158K |
| D1110 |
Prophylaxis - adult |
1,833 |
1,828 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,395 |
1,394 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,510 |
1,509 |
$71K |
| D4910 |
|
857 |
857 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,340 |
2,733 |
$60K |
| D4341 |
|
900 |
231 |
$60K |
| D1120 |
Prophylaxis - child |
1,418 |
1,418 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,345 |
3,339 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,158 |
1,156 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
210 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
268 |
180 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
111 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
248 |
156 |
$17K |
| D2954 |
|
118 |
108 |
$12K |
| D0350 |
|
1,105 |
632 |
$11K |
| D0272 |
Bitewings - two radiographic images |
816 |
814 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
686 |
674 |
$8K |
| D9430 |
|
185 |
179 |
$6K |