| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
569 |
406 |
$181K |
| D1120 |
Prophylaxis - child |
1,663 |
1,581 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
713 |
473 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,565 |
1,475 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
539 |
393 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,311 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,690 |
1,590 |
$26K |
| D1206 |
Topical application of fluoride varnish |
936 |
893 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,826 |
3,564 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,462 |
3,089 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
690 |
643 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
192 |
153 |
$14K |
| D3310 |
|
80 |
62 |
$14K |
| D2950 |
|
209 |
154 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
759 |
708 |
$12K |
| D1110 |
Prophylaxis - adult |
293 |
277 |
$10K |
| D1351 |
Sealant - per tooth |
163 |
80 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
132 |
104 |
$9K |
| D0272 |
Bitewings - two radiographic images |
623 |
588 |
$5K |
| D2331 |
|
82 |
66 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
84 |
$4K |
| D0270 |
|
103 |
85 |
$509.60 |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
58 |
$356.60 |
| D0601 |
|
424 |
390 |
$0.00 |
| D0602 |
|
197 |
173 |
$0.00 |
| D0603 |
|
186 |
171 |
$0.00 |
| D1330 |
|
251 |
214 |
$0.00 |