| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4260 |
|
955 |
318 |
$468K |
| D4910 |
|
3,187 |
3,172 |
$245K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
515 |
330 |
$244K |
| D4341 |
|
3,199 |
949 |
$224K |
| D2791 |
|
416 |
301 |
$198K |
| D1110 |
Prophylaxis - adult |
1,968 |
1,962 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
1,392 |
1,390 |
$115K |
| D2952 |
|
965 |
610 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,375 |
1,373 |
$91K |
| D2330 |
|
972 |
510 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,161 |
665 |
$63K |
| D9110 |
|
725 |
708 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,213 |
2,020 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,719 |
2,708 |
$40K |
| D1120 |
Prophylaxis - child |
704 |
699 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
612 |
612 |
$29K |
| D3320 |
|
66 |
57 |
$24K |
| D4342 |
|
491 |
187 |
$21K |
| D1320 |
|
996 |
996 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,231 |
1,231 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,218 |
1,190 |
$15K |
| D0350 |
|
1,668 |
909 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
141 |
$12K |
| D3310 |
|
39 |
25 |
$12K |
| D9430 |
|
247 |
222 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
40 |
$7K |
| D0274 |
Bitewings - four radiographic images |
226 |
226 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$861.00 |
| D1310 |
|
31 |
31 |
$15.00 |
| D1330 |
|
30 |
30 |
$0.00 |