| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
300 |
166 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,274 |
473 |
$48K |
| D1120 |
Prophylaxis - child |
1,234 |
1,152 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
774 |
444 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,306 |
1,206 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
392 |
233 |
$21K |
| D1110 |
Prophylaxis - adult |
503 |
459 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
634 |
339 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
275 |
190 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
759 |
722 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
547 |
519 |
$13K |
| D1206 |
Topical application of fluoride varnish |
574 |
524 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,422 |
2,209 |
$12K |
| D0274 |
Bitewings - four radiographic images |
797 |
729 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,049 |
1,879 |
$12K |
| D2950 |
|
208 |
128 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
394 |
363 |
$6K |
| D2331 |
|
91 |
66 |
$5K |
| D0330 |
Panoramic radiographic image |
231 |
217 |
$5K |
| D0272 |
Bitewings - two radiographic images |
389 |
367 |
$3K |
| D1351 |
Sealant - per tooth |
40 |
13 |
$1K |
| D2332 |
|
22 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
42 |
$626.30 |
| D0270 |
|
74 |
60 |
$274.40 |
| D0603 |
|
52 |
51 |
$0.00 |
| D0601 |
|
45 |
45 |
$0.00 |