| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
174 |
136 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,161 |
2,134 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,408 |
1,405 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
662 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,477 |
1,395 |
$18K |
| D1110 |
Prophylaxis - adult |
1,085 |
1,084 |
$14K |
| D4341 |
|
356 |
108 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
274 |
125 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,763 |
2,201 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
3,637 |
3,191 |
$8K |
| D2954 |
|
177 |
143 |
$7K |
| D0330 |
Panoramic radiographic image |
1,246 |
1,215 |
$5K |
| D4355 |
|
94 |
94 |
$4K |
| D7311 |
|
119 |
93 |
$4K |
| D1120 |
Prophylaxis - child |
315 |
313 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
14 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
184 |
$1K |