| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
336 |
220 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,465 |
1,456 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
391 |
$51K |
| D1110 |
Prophylaxis - adult |
532 |
530 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
1,012 |
1,008 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
243 |
80 |
$27K |
| D2954 |
|
244 |
162 |
$24K |
| D4341 |
|
383 |
107 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
389 |
195 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,110 |
1,098 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,310 |
1,159 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
293 |
288 |
$18K |
| D1120 |
Prophylaxis - child |
333 |
326 |
$15K |
| D4910 |
|
195 |
194 |
$11K |
| D0274 |
Bitewings - four radiographic images |
536 |
530 |
$9K |
| D0350 |
|
901 |
322 |
$8K |
| D9430 |
|
260 |
257 |
$7K |
| D1320 |
|
500 |
499 |
$7K |
| D3320 |
|
17 |
17 |
$6K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$97.00 |