| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
377 |
294 |
$261K |
| D1110 |
Prophylaxis - adult |
4,601 |
4,593 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,644 |
1,424 |
$174K |
| D0210 |
Intraoral - complete series of radiographic images |
3,400 |
3,393 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,688 |
5,670 |
$148K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
980 |
778 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
773 |
586 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
4,334 |
4,326 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,605 |
1,598 |
$42K |
| D2954 |
|
159 |
140 |
$23K |
| D0330 |
Panoramic radiographic image |
660 |
660 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,723 |
1,711 |
$20K |
| D5110 |
|
15 |
14 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
233 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
377 |
376 |
$5K |
| D9110 |
|
154 |
154 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
41 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
274 |
273 |
$2K |
| D0272 |
Bitewings - two radiographic images |
67 |
67 |
$1K |