| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
792 |
387 |
$327K |
| D0210 |
Intraoral - complete series of radiographic images |
612 |
579 |
$23K |
| D1110 |
Prophylaxis - adult |
622 |
604 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
884 |
845 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
402 |
400 |
$17K |
| D2954 |
|
204 |
104 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
221 |
200 |
$5K |
| D2950 |
|
122 |
64 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
79 |
78 |
$3K |
| D0274 |
Bitewings - four radiographic images |
138 |
133 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
321 |
$1K |
| D1206 |
Topical application of fluoride varnish |
65 |
65 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$228.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
25 |
$144.90 |