| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
586 |
390 |
$279K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,371 |
1,371 |
$90K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
133 |
121 |
$61K |
| D2954 |
|
531 |
368 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,134 |
1,134 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
77 |
$15K |
| D1206 |
Topical application of fluoride varnish |
804 |
802 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
80 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
153 |
153 |
$10K |
| D1120 |
Prophylaxis - child |
253 |
253 |
$8K |
| D1110 |
Prophylaxis - adult |
89 |
89 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,142 |
358 |
$5K |
| D4910 |
|
46 |
46 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
124 |
$1K |
| D0350 |
|
112 |
58 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$180.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |