| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
3,138 |
1,517 |
$1.49M |
| D4260 |
|
1,512 |
464 |
$738K |
| D4910 |
|
5,853 |
5,784 |
$431K |
| D9951 |
|
12,499 |
5,096 |
$410K |
| D2954 |
|
3,738 |
1,871 |
$388K |
| D2330 |
|
4,643 |
2,732 |
$358K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,187 |
5,154 |
$341K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,208 |
3,021 |
$277K |
| D4341 |
|
3,679 |
1,020 |
$256K |
| D1110 |
Prophylaxis - adult |
2,889 |
2,877 |
$245K |
| D0210 |
Intraoral - complete series of radiographic images |
5,031 |
5,000 |
$240K |
| D9430 |
|
6,535 |
6,234 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,575 |
1,277 |
$171K |
| D3221 |
|
2,440 |
1,330 |
$149K |
| D9910 |
|
2,017 |
1,825 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
8,749 |
8,451 |
$105K |
| D3320 |
|
279 |
218 |
$100K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
215 |
162 |
$98K |
| D2931 |
|
757 |
449 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
1,177 |
1,173 |
$83K |
| D3310 |
|
221 |
110 |
$66K |
| D5851 |
|
963 |
949 |
$64K |
| D5850 |
|
937 |
924 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,597 |
3,582 |
$50K |
| D6930 |
|
691 |
672 |
$47K |
| D2920 |
|
1,171 |
1,135 |
$45K |
| D3348 |
|
83 |
60 |
$38K |
| D5422 |
|
1,043 |
873 |
$34K |
| D2335 |
|
243 |
128 |
$29K |
| D5421 |
|
776 |
651 |
$26K |
| D3346 |
|
63 |
35 |
$19K |
| D5761 |
|
89 |
89 |
$16K |
| D4342 |
|
351 |
127 |
$15K |
| D3347 |
|
37 |
26 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
91 |
$13K |
| D5760 |
|
62 |
62 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
53 |
$5K |
| D1120 |
Prophylaxis - child |
67 |
67 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
776 |
260 |
$3K |
| D2932 |
|
30 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
83 |
83 |
$2K |