| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,627 |
866 |
$750K |
| D1110 |
Prophylaxis - adult |
2,124 |
1,971 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,066 |
1,929 |
$81K |
| D2950 |
|
1,255 |
639 |
$53K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
102 |
78 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
792 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,249 |
1,185 |
$27K |
| D2954 |
|
228 |
140 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
387 |
213 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
780 |
706 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,233 |
1,098 |
$14K |
| D0274 |
Bitewings - four radiographic images |
732 |
660 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
199 |
78 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,891 |
1,750 |
$8K |
| D1120 |
Prophylaxis - child |
126 |
114 |
$4K |
| D0330 |
Panoramic radiographic image |
230 |
176 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
914 |
729 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
38 |
$4K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
28 |
$2K |
| D4346 |
|
14 |
14 |
$490.00 |