| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,093 |
682 |
$519K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,521 |
2,508 |
$157K |
| D1110 |
Prophylaxis - adult |
1,817 |
1,807 |
$144K |
| D4341 |
|
1,948 |
571 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
1,975 |
1,966 |
$91K |
| D2952 |
|
827 |
556 |
$86K |
| D4910 |
|
856 |
854 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
457 |
303 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
554 |
548 |
$35K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
47 |
41 |
$21K |
| D3320 |
|
44 |
41 |
$16K |
| D3310 |
|
36 |
26 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
124 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,942 |
433 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
474 |
$5K |
| D1206 |
Topical application of fluoride varnish |
392 |
388 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
293 |
293 |
$4K |
| D4342 |
|
98 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
48 |
$3K |
| D9430 |
|
54 |
54 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$1K |
| D3221 |
|
13 |
13 |
$819.00 |
| D0350 |
|
40 |
28 |
$384.00 |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$367.20 |