| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
499 |
280 |
$115K |
| D1120 |
Prophylaxis - child |
1,324 |
1,209 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
693 |
358 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,995 |
1,817 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
519 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
463 |
343 |
$27K |
| D1206 |
Topical application of fluoride varnish |
972 |
868 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,318 |
1,177 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,570 |
3,075 |
$18K |
| D1110 |
Prophylaxis - adult |
495 |
443 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,806 |
2,526 |
$17K |
| D2332 |
|
225 |
128 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
550 |
493 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
835 |
739 |
$13K |
| D3310 |
|
74 |
44 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
222 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
96 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
203 |
201 |
$5K |
| D9110 |
|
101 |
79 |
$4K |
| D0272 |
Bitewings - two radiographic images |
548 |
506 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
213 |
$3K |
| D0330 |
Panoramic radiographic image |
129 |
127 |
$2K |
| D2950 |
|
28 |
14 |
$2K |
| D2335 |
|
16 |
13 |
$927.00 |
| D0602 |
|
107 |
78 |
$702.00 |
| D0270 |
|
70 |
41 |
$313.60 |
| D0603 |
|
43 |
31 |
$54.00 |
| D1330 |
|
178 |
124 |
$0.00 |
| D0601 |
|
20 |
20 |
$0.00 |