| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
957 |
948 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
735 |
728 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
93 |
66 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
550 |
544 |
$40K |
| D1110 |
Prophylaxis - adult |
404 |
398 |
$36K |
| D9110 |
|
412 |
398 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,937 |
1,748 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
473 |
467 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
147 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,464 |
1,531 |
$19K |
| D4341 |
|
253 |
74 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,100 |
1,090 |
$14K |
| D0350 |
|
1,605 |
421 |
$13K |
| D9430 |
|
290 |
272 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
16 |
$2K |
| D1120 |
Prophylaxis - child |
43 |
43 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D5850 |
|
17 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$198.00 |
| D9995 |
|
19 |
19 |
$120.48 |