| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
348 |
277 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,140 |
2,132 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
1,592 |
1,591 |
$116K |
| D1110 |
Prophylaxis - adult |
1,009 |
1,007 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,432 |
1,425 |
$68K |
| D4341 |
|
941 |
293 |
$65K |
| D1120 |
Prophylaxis - child |
1,472 |
1,470 |
$64K |
| D9430 |
|
1,549 |
1,339 |
$49K |
| D4910 |
|
595 |
595 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,666 |
3,003 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
549 |
390 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,587 |
2,583 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,633 |
1,632 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
258 |
131 |
$31K |
| D0350 |
|
3,087 |
1,155 |
$30K |
| D1351 |
Sealant - per tooth |
946 |
221 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,313 |
1,245 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
209 |
148 |
$11K |
| D4342 |
|
136 |
54 |
$6K |
| D2954 |
|
54 |
51 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
28 |
$4K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |