| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
441 |
334 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,883 |
1,880 |
$122K |
| D1110 |
Prophylaxis - adult |
1,202 |
1,196 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
1,112 |
1,103 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,483 |
1,482 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
834 |
535 |
$55K |
| D4341 |
|
676 |
233 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
342 |
200 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,164 |
1,694 |
$36K |
| D9430 |
|
1,114 |
1,063 |
$35K |
| D0350 |
|
3,043 |
1,382 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,122 |
1,113 |
$23K |
| D1320 |
|
1,257 |
1,249 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
282 |
182 |
$15K |
| D4910 |
|
173 |
168 |
$13K |
| D2954 |
|
120 |
100 |
$13K |
| D1120 |
Prophylaxis - child |
236 |
234 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
726 |
711 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
107 |
60 |
$7K |
| D1206 |
Topical application of fluoride varnish |
408 |
406 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
511 |
505 |
$7K |
| D2330 |
|
61 |
43 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
58 |
44 |
$5K |
| D9110 |
|
70 |
66 |
$4K |
| D4342 |
|
30 |
12 |
$1K |
| D2160 |
|
15 |
12 |
$1K |
| D2140 |
|
16 |
12 |
$873.60 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$486.00 |