| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,135 |
674 |
$526K |
| D2740 |
Crown - porcelain/ceramic |
523 |
262 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
2,338 |
2,293 |
$92K |
| D1110 |
Prophylaxis - adult |
1,828 |
1,785 |
$65K |
| D2954 |
|
688 |
419 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,148 |
1,130 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,969 |
1,939 |
$40K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
81 |
55 |
$39K |
| D1120 |
Prophylaxis - child |
992 |
988 |
$35K |
| D2950 |
|
655 |
342 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
487 |
301 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,013 |
982 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
466 |
141 |
$20K |
| D1206 |
Topical application of fluoride varnish |
606 |
603 |
$13K |
| D0274 |
Bitewings - four radiographic images |
826 |
822 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
186 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
571 |
555 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,402 |
1,348 |
$6K |
| D3320 |
|
15 |
12 |
$4K |
| D0330 |
Panoramic radiographic image |
235 |
232 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
659 |
314 |
$1K |
| D4346 |
|
33 |
33 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
14 |
$961.00 |