| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
1,169 |
1,164 |
$90K |
| D1110 |
Prophylaxis - adult |
1,003 |
997 |
$88K |
| D2332 |
|
1,016 |
177 |
$80K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
143 |
95 |
$68K |
| D4341 |
|
845 |
233 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
841 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
591 |
586 |
$52K |
| D9430 |
|
1,394 |
1,149 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
656 |
655 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
447 |
232 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,436 |
1,430 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,560 |
1,243 |
$18K |
| D0350 |
|
1,764 |
578 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,216 |
1,080 |
$14K |
| D2954 |
|
115 |
79 |
$12K |
| D1120 |
Prophylaxis - child |
229 |
228 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
50 |
$7K |
| D0272 |
Bitewings - two radiographic images |
374 |
374 |
$4K |
| D0274 |
Bitewings - four radiographic images |
132 |
130 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
136 |
25 |
$2K |
| D4342 |
|
35 |
12 |
$1K |