| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
155 |
89 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,206 |
1,192 |
$72K |
| D1110 |
Prophylaxis - adult |
381 |
378 |
$27K |
| D2952 |
|
146 |
89 |
$15K |
| D0274 |
Bitewings - four radiographic images |
727 |
710 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
52 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
68 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,854 |
1,028 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
31 |
$300.00 |