| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
338 |
282 |
$198K |
| D1110 |
Prophylaxis - adult |
1,445 |
1,442 |
$56K |
| D2954 |
|
316 |
287 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,836 |
1,829 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,560 |
2,273 |
$36K |
| D7510 |
|
676 |
674 |
$29K |
| D2920 |
|
646 |
600 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,646 |
1,509 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,345 |
1,272 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
1,326 |
1,187 |
$10K |
| D0330 |
Panoramic radiographic image |
423 |
422 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
117 |
$7K |
| D1320 |
|
869 |
869 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
73 |
$6K |
| D0274 |
Bitewings - four radiographic images |
236 |
236 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$4K |
| D2330 |
|
54 |
46 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
261 |
261 |
$3K |
| D4910 |
|
84 |
83 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
29 |
$2K |
| D9110 |
|
220 |
214 |
$1K |
| D1120 |
Prophylaxis - child |
46 |
46 |
$1K |
| D6930 |
|
13 |
13 |
$348.24 |
| D1999 |
|
122 |
87 |
$0.00 |