| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
737 |
535 |
$351K |
| D0350 |
|
13,912 |
3,449 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,270 |
1,270 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,210 |
535 |
$81K |
| D4341 |
|
1,153 |
341 |
$81K |
| D2954 |
|
742 |
539 |
$78K |
| D4910 |
|
930 |
925 |
$71K |
| D9430 |
|
2,165 |
1,702 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
905 |
900 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
139 |
119 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,184 |
1,184 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
440 |
229 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,325 |
2,320 |
$30K |
| D0274 |
Bitewings - four radiographic images |
983 |
977 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,628 |
1,619 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,279 |
1,179 |
$15K |
| D1120 |
Prophylaxis - child |
328 |
327 |
$14K |
| D4342 |
|
174 |
63 |
$7K |
| D2394 |
|
60 |
51 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
13 |
$3K |
| D1330 |
|
426 |
426 |
$0.00 |