| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
275 |
142 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,225 |
439 |
$49K |
| D1120 |
Prophylaxis - child |
665 |
632 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
549 |
273 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
782 |
732 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
350 |
186 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
677 |
636 |
$14K |
| D0274 |
Bitewings - four radiographic images |
686 |
645 |
$11K |
| D1110 |
Prophylaxis - adult |
270 |
242 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,817 |
1,647 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,225 |
1,366 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
154 |
109 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
315 |
307 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
145 |
$7K |
| D2140 |
|
221 |
134 |
$7K |
| D1206 |
Topical application of fluoride varnish |
207 |
191 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
320 |
299 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
41 |
$4K |
| D2950 |
|
59 |
43 |
$3K |
| D2160 |
|
40 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
217 |
203 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
29 |
$542.40 |
| D0270 |
|
21 |
14 |
$84.00 |