| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
397 |
254 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
753 |
750 |
$48K |
| D1110 |
Prophylaxis - adult |
504 |
501 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
477 |
183 |
$32K |
| D4910 |
|
380 |
379 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
382 |
377 |
$26K |
| D9430 |
|
798 |
731 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
466 |
461 |
$22K |
| D2954 |
|
167 |
103 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,147 |
1,140 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,263 |
1,103 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
748 |
697 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
60 |
$8K |
| D0350 |
|
361 |
278 |
$8K |
| D1120 |
Prophylaxis - child |
125 |
120 |
$5K |
| D0274 |
Bitewings - four radiographic images |
164 |
164 |
$3K |
| D4341 |
|
42 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
106 |
106 |
$2K |