| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
918 |
733 |
$396K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,300 |
2,416 |
$213K |
| D1110 |
Prophylaxis - adult |
6,219 |
6,195 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
6,836 |
6,813 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
3,554 |
3,541 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,458 |
1,036 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,685 |
2,676 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,264 |
544 |
$67K |
| D1351 |
Sealant - per tooth |
4,971 |
910 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,578 |
4,564 |
$43K |
| D1120 |
Prophylaxis - child |
2,386 |
2,378 |
$35K |
| D0274 |
Bitewings - four radiographic images |
3,364 |
3,358 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
676 |
488 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
4,521 |
4,464 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,213 |
3,926 |
$17K |
| D2954 |
|
181 |
158 |
$12K |
| D0601 |
|
1,368 |
1,363 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
861 |
843 |
$7K |
| D2332 |
|
17 |
12 |
$1K |
| D0350 |
|
470 |
463 |
$379.00 |
| D9211 |
|
164 |
158 |
$0.00 |
| D9212 |
|
261 |
244 |
$0.00 |
| D1353 |
|
48 |
15 |
$0.00 |