| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
938 |
339 |
$445K |
| D2952 |
|
871 |
309 |
$90K |
| D3310 |
|
238 |
90 |
$72K |
| D1110 |
Prophylaxis - adult |
724 |
721 |
$56K |
| D4341 |
|
558 |
194 |
$34K |
| D3320 |
|
34 |
24 |
$12K |
| D5750 |
|
69 |
69 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
124 |
$8K |
| D5751 |
|
40 |
40 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
116 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
24 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
234 |
233 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
43 |
$1K |