| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
4,295 |
1,783 |
$2.04M |
| D2954 |
|
3,470 |
1,586 |
$364K |
| D3310 |
|
559 |
274 |
$169K |
| D1110 |
Prophylaxis - adult |
1,821 |
1,810 |
$148K |
| D4341 |
|
1,251 |
338 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,371 |
1,359 |
$79K |
| D3320 |
|
176 |
145 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
273 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
608 |
598 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
689 |
679 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,147 |
2,136 |
$28K |
| D3348 |
|
34 |
31 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
108 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
55 |
$7K |
| D2394 |
|
70 |
47 |
$6K |
| D3347 |
|
16 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
202 |
$3K |
| D2330 |
|
24 |
12 |
$2K |
| D9430 |
|
29 |
29 |
$928.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |