| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
777 |
544 |
$370K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,771 |
3,752 |
$245K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,363 |
937 |
$159K |
| D1110 |
Prophylaxis - adult |
1,694 |
1,691 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,028 |
1,295 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
2,091 |
2,086 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,452 |
1,017 |
$115K |
| D4341 |
|
1,495 |
397 |
$104K |
| D1120 |
Prophylaxis - child |
2,131 |
2,123 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,929 |
4,084 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,264 |
1,260 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,152 |
2,138 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,446 |
2,437 |
$33K |
| D9430 |
|
700 |
696 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
315 |
206 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,271 |
1,264 |
$15K |
| D3221 |
|
226 |
204 |
$14K |
| D2952 |
|
120 |
102 |
$12K |
| D2954 |
|
116 |
72 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,065 |
1,062 |
$12K |
| D4910 |
|
123 |
121 |
$9K |
| D3310 |
|
24 |
13 |
$7K |
| D0272 |
Bitewings - two radiographic images |
598 |
597 |
$7K |
| D1351 |
Sealant - per tooth |
284 |
114 |
$6K |
| D3320 |
|
15 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
25 |
$2K |
| D9951 |
|
64 |
48 |
$2K |
| D2332 |
|
18 |
13 |
$1K |
| D0270 |
|
26 |
26 |
$120.00 |
| D0350 |
|
58 |
58 |
$19.20 |