| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
495 |
342 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
362 |
195 |
$14K |
| D1110 |
Prophylaxis - adult |
807 |
806 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
834 |
796 |
$12K |
| D2950 |
|
227 |
187 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
351 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
395 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
599 |
599 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
36 |
33 |
$8K |
| D3320 |
|
40 |
37 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,624 |
1,461 |
$6K |
| D0274 |
Bitewings - four radiographic images |
507 |
507 |
$5K |
| D4341 |
|
121 |
38 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
881 |
851 |
$3K |
| D2954 |
|
54 |
43 |
$2K |
| D3310 |
|
17 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
183 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
25 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$836.00 |
| D1120 |
Prophylaxis - child |
31 |
31 |
$434.00 |
| D1999 |
|
95 |
82 |
$0.00 |