| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
314 |
239 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,657 |
1,653 |
$109K |
| D1110 |
Prophylaxis - adult |
830 |
827 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,359 |
1,353 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
883 |
880 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
821 |
516 |
$55K |
| D9430 |
|
1,255 |
1,175 |
$40K |
| D1120 |
Prophylaxis - child |
834 |
829 |
$38K |
| D0350 |
|
3,659 |
1,259 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,122 |
1,683 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
221 |
144 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
476 |
310 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,131 |
1,889 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,635 |
1,629 |
$22K |
| D4341 |
|
232 |
67 |
$16K |
| D2954 |
|
143 |
114 |
$15K |
| D0274 |
Bitewings - four radiographic images |
669 |
668 |
$14K |
| D1351 |
Sealant - per tooth |
166 |
40 |
$6K |
| D4910 |
|
84 |
83 |
$6K |
| D9110 |
|
62 |
54 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
31 |
$3K |
| D1206 |
Topical application of fluoride varnish |
72 |
72 |
$1K |
| D1330 |
|
21 |
21 |
$0.00 |