| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,193 |
797 |
$564K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,738 |
1,555 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,855 |
2,834 |
$176K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,477 |
910 |
$173K |
| D9430 |
|
4,567 |
4,155 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
2,731 |
2,712 |
$131K |
| D1110 |
Prophylaxis - adult |
1,336 |
1,330 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
2,064 |
2,054 |
$96K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
181 |
164 |
$84K |
| D2954 |
|
612 |
404 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
643 |
490 |
$51K |
| D4910 |
|
632 |
631 |
$48K |
| D4341 |
|
600 |
188 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,951 |
2,500 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,767 |
2,633 |
$33K |
| D3310 |
|
67 |
43 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,217 |
1,214 |
$15K |
| D9110 |
|
248 |
215 |
$14K |
| D0272 |
Bitewings - two radiographic images |
853 |
834 |
$10K |
| D1120 |
Prophylaxis - child |
271 |
271 |
$9K |
| D3320 |
|
14 |
13 |
$5K |
| D2952 |
|
30 |
25 |
$3K |
| D5410 |
|
12 |
12 |
$420.00 |