| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
341 |
244 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
2,471 |
2,464 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,416 |
1,410 |
$84K |
| D1120 |
Prophylaxis - child |
1,967 |
1,960 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,458 |
1,450 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
882 |
476 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,171 |
2,784 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
288 |
162 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,584 |
2,572 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,464 |
1,461 |
$30K |
| D9430 |
|
835 |
749 |
$27K |
| D1110 |
Prophylaxis - adult |
333 |
330 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
372 |
203 |
$25K |
| D2954 |
|
215 |
167 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
26 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
108 |
$10K |
| D0350 |
|
1,055 |
419 |
$9K |
| D4341 |
|
97 |
26 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
48 |
$6K |
| D1351 |
Sealant - per tooth |
240 |
54 |
$5K |
| D0272 |
Bitewings - two radiographic images |
289 |
289 |
$3K |
| D2140 |
|
38 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
220 |
219 |
$2K |
| D1999 |
|
145 |
142 |
$80.00 |
| D1330 |
|
13 |
13 |
$0.00 |