| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
2,450 |
1,335 |
$1.25M |
| D4341 |
|
6,105 |
1,708 |
$444K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,238 |
1,667 |
$305K |
| D5214 |
|
362 |
362 |
$252K |
| D1110 |
Prophylaxis - adult |
3,332 |
3,325 |
$243K |
| D5213 |
|
245 |
245 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,433 |
1,297 |
$168K |
| D2331 |
|
1,585 |
698 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,254 |
2,250 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,808 |
2,803 |
$80K |
| D1351 |
Sealant - per tooth |
2,316 |
371 |
$77K |
| D1120 |
Prophylaxis - child |
1,445 |
1,443 |
$75K |
| D2952 |
|
575 |
339 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,401 |
1,399 |
$72K |
| D2330 |
|
847 |
403 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,953 |
1,951 |
$45K |
| D5110 |
|
68 |
68 |
$40K |
| D7250 |
|
211 |
116 |
$36K |
| D2954 |
|
265 |
176 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,454 |
1,452 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,564 |
3,538 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
272 |
133 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
142 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
52 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,009 |
1,002 |
$13K |
| D2332 |
|
140 |
87 |
$12K |
| D0272 |
Bitewings - two radiographic images |
666 |
665 |
$8K |
| D4910 |
|
82 |
82 |
$6K |
| D5850 |
|
62 |
62 |
$4K |
| D5211 |
|
12 |
12 |
$4K |
| D5851 |
|
55 |
55 |
$4K |
| D3221 |
|
29 |
24 |
$2K |