| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
333 |
188 |
$159K |
| D1110 |
Prophylaxis - adult |
1,141 |
1,133 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,420 |
$90K |
| D2954 |
|
608 |
334 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,355 |
1,346 |
$63K |
| D7510 |
|
881 |
762 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
956 |
954 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,098 |
2,650 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,475 |
3,655 |
$45K |
| D9430 |
|
1,304 |
1,171 |
$41K |
| D4910 |
|
476 |
476 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
258 |
161 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,992 |
1,982 |
$27K |
| D4341 |
|
298 |
82 |
$21K |
| D1320 |
|
1,030 |
1,025 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
32 |
28 |
$15K |
| D0274 |
Bitewings - four radiographic images |
711 |
707 |
$15K |
| D1120 |
Prophylaxis - child |
253 |
252 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
112 |
41 |
$9K |
| D2931 |
|
60 |
37 |
$8K |
| D3320 |
|
16 |
12 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
13 |
$2K |
| D7520 |
|
12 |
12 |
$1K |