| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,510 |
805 |
$748K |
| D0120 |
Periodic oral evaluation - established patient |
1,823 |
1,764 |
$74K |
| D1110 |
Prophylaxis - adult |
1,634 |
1,573 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
850 |
826 |
$34K |
| D2954 |
|
402 |
250 |
$33K |
| D2950 |
|
658 |
330 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
1,058 |
$24K |
| D2740 |
Crown - porcelain/ceramic |
63 |
27 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
654 |
621 |
$15K |
| D3320 |
|
34 |
24 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
42 |
$11K |
| D0274 |
Bitewings - four radiographic images |
491 |
482 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
77 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,648 |
1,549 |
$7K |
| D0330 |
Panoramic radiographic image |
348 |
322 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
489 |
460 |
$6K |
| D1120 |
Prophylaxis - child |
122 |
122 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
846 |
526 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$644.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$269.10 |