| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,060 |
689 |
$594K |
| D1110 |
Prophylaxis - adult |
5,390 |
5,227 |
$276K |
| D2950 |
|
730 |
484 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,444 |
971 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,631 |
4,507 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,161 |
848 |
$91K |
| D0274 |
Bitewings - four radiographic images |
2,219 |
2,165 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,435 |
1,345 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
720 |
690 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
976 |
931 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,249 |
1,214 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,932 |
1,857 |
$29K |
| D1120 |
Prophylaxis - child |
451 |
441 |
$22K |
| D2332 |
|
126 |
76 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
870 |
706 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
101 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
13 |
$4K |
| D2394 |
|
20 |
14 |
$2K |