| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
888 |
565 |
$423K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,635 |
1,624 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,701 |
1,695 |
$95K |
| D1110 |
Prophylaxis - adult |
1,146 |
1,145 |
$93K |
| D2952 |
|
834 |
571 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
971 |
537 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,017 |
1,010 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
748 |
411 |
$40K |
| D4910 |
|
452 |
452 |
$34K |
| D9430 |
|
977 |
931 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,028 |
2,019 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,932 |
1,555 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
41 |
$19K |
| D4341 |
|
257 |
68 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,491 |
1,438 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
73 |
$11K |
| D1120 |
Prophylaxis - child |
334 |
334 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
75 |
$8K |
| D3221 |
|
43 |
41 |
$3K |
| D0350 |
|
322 |
164 |
$3K |
| D0272 |
Bitewings - two radiographic images |
240 |
239 |
$3K |
| D5850 |
|
29 |
29 |
$2K |
| D5851 |
|
27 |
27 |
$2K |
| D2330 |
|
23 |
12 |
$2K |