| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
2,999 |
794 |
$210K |
| D1110 |
Prophylaxis - adult |
2,148 |
2,140 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
2,802 |
2,784 |
$155K |
| D9430 |
|
3,986 |
3,819 |
$126K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
259 |
195 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,903 |
1,896 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
2,114 |
2,106 |
$99K |
| D4910 |
|
1,255 |
1,245 |
$96K |
| D0350 |
|
8,002 |
3,178 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
719 |
350 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,333 |
3,586 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,937 |
2,926 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,103 |
3,037 |
$37K |
| D2160 |
|
324 |
167 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
107 |
$12K |
| D0274 |
Bitewings - four radiographic images |
563 |
560 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
54 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
36 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
41 |
$4K |
| D2954 |
|
18 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$2K |
| D2330 |
|
19 |
12 |
$1K |