| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
964 |
567 |
$453K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
692 |
671 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
323 |
$44K |
| D1110 |
Prophylaxis - adult |
478 |
468 |
$41K |
| D2954 |
|
287 |
202 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
570 |
555 |
$27K |
| D4341 |
|
375 |
100 |
$26K |
| D4910 |
|
275 |
274 |
$21K |
| D9430 |
|
576 |
515 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
133 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
949 |
863 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
155 |
155 |
$11K |
| D0350 |
|
1,133 |
417 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
760 |
742 |
$10K |
| D1120 |
Prophylaxis - child |
185 |
178 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,860 |
1,013 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
124 |
123 |
$3K |