| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
511 |
392 |
$243K |
| D4910 |
|
2,895 |
2,854 |
$220K |
| D9430 |
|
4,230 |
3,870 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,058 |
4,005 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,388 |
1,354 |
$82K |
| D1110 |
Prophylaxis - adult |
848 |
841 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
898 |
888 |
$41K |
| D4341 |
|
587 |
162 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,252 |
4,198 |
$33K |
| D1120 |
Prophylaxis - child |
654 |
649 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,489 |
1,281 |
$23K |
| D2954 |
|
132 |
103 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,143 |
1,105 |
$13K |
| D2161 |
|
145 |
108 |
$12K |
| D9110 |
|
72 |
66 |
$5K |
| D1351 |
Sealant - per tooth |
67 |
12 |
$3K |
| D2335 |
|
17 |
12 |
$2K |
| D2931 |
|
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
83 |
82 |
$955.50 |