| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
1,396 |
1,379 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
1,459 |
1,439 |
$101K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
174 |
130 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,107 |
1,097 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
993 |
561 |
$67K |
| D1110 |
Prophylaxis - adult |
710 |
695 |
$63K |
| D1120 |
Prophylaxis - child |
1,147 |
1,137 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
621 |
351 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,102 |
2,073 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,157 |
1,144 |
$25K |
| D4341 |
|
341 |
97 |
$24K |
| D0350 |
|
2,325 |
844 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
390 |
389 |
$19K |
| D9430 |
|
568 |
545 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,437 |
2,422 |
$18K |
| D0330 |
Panoramic radiographic image |
503 |
497 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
899 |
844 |
$11K |
| D2954 |
|
71 |
51 |
$7K |
| D0272 |
Bitewings - two radiographic images |
444 |
443 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$1K |
| D4342 |
|
35 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
14 |
$1K |