| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
324 |
221 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
2,821 |
2,811 |
$151K |
| D1110 |
Prophylaxis - adult |
1,635 |
1,624 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,548 |
1,546 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,615 |
1,603 |
$75K |
| D4910 |
|
651 |
648 |
$50K |
| D1120 |
Prophylaxis - child |
1,160 |
1,153 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,389 |
2,246 |
$31K |
| D4341 |
|
397 |
116 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,192 |
2,176 |
$25K |
| D9430 |
|
779 |
764 |
$24K |
| D0350 |
|
2,418 |
939 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,469 |
1,459 |
$17K |
| D2952 |
|
107 |
73 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
938 |
894 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
92 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
24 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
26 |
$3K |
| D4342 |
|
38 |
12 |
$2K |
| D0270 |
|
206 |
202 |
$1K |
| D1330 |
|
1,702 |
1,688 |
$0.00 |