| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
868 |
712 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
3,178 |
3,132 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,576 |
789 |
$73K |
| D1110 |
Prophylaxis - adult |
2,517 |
2,478 |
$58K |
| D4355 |
|
966 |
951 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,643 |
1,622 |
$52K |
| D2950 |
|
882 |
719 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,534 |
1,515 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,139 |
2,120 |
$33K |
| D1120 |
Prophylaxis - child |
1,381 |
1,369 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,403 |
3,514 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
553 |
311 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,905 |
4,609 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,533 |
1,519 |
$18K |
| D1351 |
Sealant - per tooth |
1,032 |
173 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
538 |
538 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
28 |
$11K |
| D0601 |
|
487 |
486 |
$5K |
| D0602 |
|
147 |
145 |
$1K |
| D9110 |
|
27 |
26 |
$269.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$152.50 |