| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
376 |
340 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
547 |
$36K |
| D2950 |
|
312 |
283 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
220 |
115 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
114 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
708 |
685 |
$22K |
| D1110 |
Prophylaxis - adult |
457 |
439 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
455 |
441 |
$15K |
| D0274 |
Bitewings - four radiographic images |
434 |
420 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
571 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
446 |
$7K |
| D4341 |
|
45 |
27 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
27 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
32 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
86 |
$2K |
| D0270 |
|
83 |
83 |
$1K |
| D1120 |
Prophylaxis - child |
29 |
27 |
$768.61 |