| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
441 |
307 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,485 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,343 |
1,334 |
$59K |
| D1110 |
Prophylaxis - adult |
751 |
746 |
$58K |
| D2954 |
|
421 |
294 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,420 |
1,393 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
403 |
236 |
$25K |
| D9430 |
|
526 |
477 |
$15K |
| D1120 |
Prophylaxis - child |
490 |
487 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
486 |
481 |
$13K |
| D0350 |
|
1,578 |
842 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
44 |
$5K |
| D0272 |
Bitewings - two radiographic images |
451 |
444 |
$5K |
| D2160 |
|
58 |
44 |
$4K |
| D2140 |
|
72 |
45 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
27 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
14 |
$3K |
| D4341 |
|
36 |
13 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
143 |
142 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
137 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
37 |
$0.00 |