| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,517 |
425 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,220 |
1,210 |
$80K |
| D1110 |
Prophylaxis - adult |
789 |
784 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,112 |
1,103 |
$53K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
29 |
$20K |
| D4342 |
|
262 |
99 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
770 |
766 |
$10K |
| D3221 |
|
135 |
68 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
52 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
37 |
$6K |
| D2932 |
|
58 |
45 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D3310 |
|
17 |
12 |
$5K |
| D2954 |
|
20 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
68 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |