| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
1,550 |
1,273 |
$49K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
93 |
48 |
$44K |
| D1110 |
Prophylaxis - adult |
311 |
310 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
365 |
364 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,139 |
1,039 |
$22K |
| D4910 |
|
282 |
281 |
$22K |
| D4341 |
|
236 |
62 |
$17K |
| D1206 |
Topical application of fluoride varnish |
817 |
812 |
$14K |
| D0274 |
Bitewings - four radiographic images |
629 |
627 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
51 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
162 |
162 |
$13K |
| D0330 |
Panoramic radiographic image |
321 |
313 |
$9K |
| D1120 |
Prophylaxis - child |
179 |
177 |
$9K |
| D1320 |
|
540 |
536 |
$8K |
| D2954 |
|
50 |
28 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
253 |
$3K |
| D9110 |
|
33 |
24 |
$2K |
| D0350 |
|
83 |
26 |
$892.80 |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$165.00 |