| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
231 |
145 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,031 |
1,024 |
$57K |
| D1110 |
Prophylaxis - adult |
563 |
555 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
382 |
380 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
78 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
321 |
318 |
$11K |
| D2954 |
|
102 |
70 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
505 |
499 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
742 |
707 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,206 |
319 |
$5K |
| D4341 |
|
75 |
24 |
$4K |
| D1320 |
|
209 |
208 |
$3K |
| D1120 |
Prophylaxis - child |
139 |
137 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$309.00 |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$114.00 |
| D1330 |
|
72 |
70 |
$0.00 |