| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
352 |
256 |
$168K |
| D1110 |
Prophylaxis - adult |
1,629 |
1,611 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
2,128 |
2,101 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,783 |
1,755 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,224 |
1,214 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,947 |
1,708 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,826 |
2,806 |
$33K |
| D4341 |
|
451 |
119 |
$31K |
| D1120 |
Prophylaxis - child |
901 |
896 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,110 |
1,093 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
67 |
$8K |
| D2140 |
|
132 |
53 |
$7K |
| D2954 |
|
65 |
46 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
27 |
$2K |
| D1351 |
Sealant - per tooth |
106 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$873.60 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$321.00 |