| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
860 |
556 |
$408K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,077 |
2,072 |
$131K |
| D2954 |
|
861 |
619 |
$90K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
116 |
100 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,085 |
1,079 |
$51K |
| D1110 |
Prophylaxis - adult |
423 |
423 |
$37K |
| D4341 |
|
407 |
149 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,001 |
1,059 |
$24K |
| D1320 |
|
915 |
914 |
$13K |
| D0274 |
Bitewings - four radiographic images |
625 |
623 |
$12K |
| D4910 |
|
149 |
148 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
686 |
685 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
130 |
128 |
$8K |
| D9430 |
|
34 |
34 |
$1K |
| D0180 |
|
13 |
13 |
$0.00 |