| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,358 |
2,760 |
$1.88M |
| D1110 |
Prophylaxis - adult |
6,190 |
6,137 |
$288K |
| D0140 |
Limited oral evaluation - problem focused |
6,127 |
6,027 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
7,042 |
6,989 |
$183K |
| D0210 |
Intraoral - complete series of radiographic images |
3,059 |
3,033 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,503 |
1,880 |
$126K |
| D2950 |
|
2,036 |
1,730 |
$113K |
| D2954 |
|
725 |
623 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,619 |
1,188 |
$65K |
| D1120 |
Prophylaxis - child |
982 |
977 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
636 |
523 |
$38K |
| D0274 |
Bitewings - four radiographic images |
3,134 |
3,109 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
6,445 |
6,279 |
$33K |
| D2331 |
|
447 |
315 |
$29K |
| D0330 |
Panoramic radiographic image |
839 |
832 |
$28K |
| D2335 |
|
240 |
162 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
701 |
700 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,512 |
3,380 |
$14K |
| D0170 |
|
150 |
146 |
$6K |
| D2330 |
|
105 |
79 |
$5K |
| D2332 |
|
48 |
38 |
$4K |
| D1206 |
Topical application of fluoride varnish |
47 |
41 |
$1K |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$535.50 |
| D1999 |
|
325 |
297 |
$0.00 |