| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
476 |
333 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,358 |
1,355 |
$89K |
| D0350 |
|
8,687 |
2,282 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,201 |
658 |
$80K |
| D2954 |
|
485 |
347 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,008 |
1,007 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
717 |
709 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
835 |
419 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,145 |
1,616 |
$38K |
| D1120 |
Prophylaxis - child |
640 |
634 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
231 |
97 |
$27K |
| D1110 |
Prophylaxis - adult |
281 |
281 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
52 |
45 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,132 |
1,123 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
284 |
191 |
$22K |
| D9430 |
|
376 |
350 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
848 |
843 |
$11K |
| D4910 |
|
130 |
130 |
$10K |
| D2394 |
|
76 |
56 |
$6K |
| D1206 |
Topical application of fluoride varnish |
183 |
183 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$180.00 |
| D1999 |
|
337 |
244 |
$100.00 |