| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
839 |
443 |
$397K |
| D1110 |
Prophylaxis - adult |
1,899 |
1,881 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,220 |
2,206 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,759 |
776 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
1,923 |
1,897 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,164 |
627 |
$91K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
749 |
308 |
$87K |
| D2954 |
|
786 |
432 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,581 |
1,572 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,390 |
556 |
$72K |
| D1120 |
Prophylaxis - child |
1,216 |
1,204 |
$47K |
| D2330 |
|
645 |
132 |
$46K |
| D0350 |
|
4,495 |
1,520 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,522 |
1,507 |
$32K |
| D2931 |
|
235 |
179 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,072 |
2,759 |
$24K |
| D3320 |
|
46 |
37 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,356 |
1,345 |
$16K |
| D9430 |
|
446 |
432 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
695 |
683 |
$8K |
| D3310 |
|
23 |
13 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
191 |
190 |
$2K |