| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,326 |
621 |
$764K |
| D4381 |
|
1,233 |
421 |
$193K |
| D4341 |
|
1,357 |
379 |
$147K |
| D4211 |
|
1,242 |
573 |
$97K |
| D2950 |
|
510 |
248 |
$86K |
| D4260 |
|
107 |
73 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,442 |
1,384 |
$78K |
| D1110 |
Prophylaxis - adult |
855 |
837 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,194 |
1,141 |
$70K |
| D4910 |
|
882 |
862 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
674 |
412 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
235 |
149 |
$35K |
| D0350 |
|
2,586 |
1,052 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
960 |
952 |
$16K |
| D9910 |
|
422 |
194 |
$15K |
| D3331 |
|
33 |
24 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
113 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
85 |
$11K |
| D2330 |
|
117 |
51 |
$10K |
| D7910 |
|
121 |
82 |
$7K |
| D0274 |
Bitewings - four radiographic images |
217 |
216 |
$5K |
| D9911 |
|
159 |
65 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
801 |
346 |
$3K |
| D9310 |
|
16 |
12 |
$1K |