| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
471 |
389 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
3,521 |
3,204 |
$22K |
| D2950 |
|
740 |
675 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
99 |
92 |
$13K |
| D0330 |
Panoramic radiographic image |
1,408 |
1,360 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
4,888 |
4,549 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,807 |
2,050 |
$6K |
| D0274 |
Bitewings - four radiographic images |
757 |
737 |
$4K |
| D1110 |
Prophylaxis - adult |
361 |
355 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
126 |
64 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
487 |
482 |
$3K |
| D1120 |
Prophylaxis - child |
303 |
297 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
645 |
632 |
$2K |
| D0270 |
|
1,209 |
1,144 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
260 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$644.96 |
| D0272 |
Bitewings - two radiographic images |
60 |
56 |
$323.01 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
29 |
$270.20 |
| D1999 |
|
17 |
16 |
$6.00 |
| D9431 |
|
18 |
14 |
$0.00 |