| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
527 |
406 |
$251K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
779 |
400 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,107 |
1,104 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
819 |
817 |
$39K |
| D2952 |
|
307 |
263 |
$32K |
| D9430 |
|
930 |
871 |
$30K |
| D1110 |
Prophylaxis - adult |
238 |
238 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
245 |
244 |
$20K |
| D4910 |
|
211 |
209 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,953 |
1,028 |
$12K |
| D1320 |
|
725 |
722 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
648 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
64 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D0274 |
Bitewings - four radiographic images |
214 |
213 |
$5K |
| D4341 |
|
46 |
12 |
$3K |
| D0350 |
|
151 |
91 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
62 |
$2K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
81 |
$984.00 |
| D0270 |
|
26 |
26 |
$130.00 |