| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
753 |
581 |
$271K |
| D1110 |
Prophylaxis - adult |
4,946 |
4,944 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
4,183 |
4,182 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,444 |
3,444 |
$65K |
| D2954 |
|
580 |
481 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,843 |
5,825 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,320 |
5,312 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
1,686 |
1,681 |
$41K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
151 |
141 |
$39K |
| D6010 |
|
37 |
25 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,672 |
1,672 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
576 |
441 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
595 |
385 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,366 |
1,356 |
$14K |
| D1120 |
Prophylaxis - child |
233 |
233 |
$7K |
| D0272 |
Bitewings - two radiographic images |
299 |
299 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
36 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
199 |
199 |
$2K |
| D3320 |
|
13 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
13 |
$1K |
| D1320 |
|
42 |
42 |
$336.00 |
| D0270 |
|
30 |
30 |
$294.18 |