| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
599 |
435 |
$285K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,461 |
1,460 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,416 |
1,413 |
$91K |
| D4910 |
|
812 |
806 |
$61K |
| D1120 |
Prophylaxis - child |
1,417 |
1,409 |
$56K |
| D2952 |
|
532 |
397 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,076 |
1,074 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,151 |
2,440 |
$43K |
| D4341 |
|
549 |
153 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
258 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,050 |
2,045 |
$26K |
| D1110 |
Prophylaxis - adult |
301 |
301 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,110 |
1,108 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
53 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
50 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
55 |
$5K |
| D1351 |
Sealant - per tooth |
223 |
53 |
$5K |
| D9430 |
|
131 |
126 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
341 |
335 |
$4K |
| D2940 |
|
51 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
14 |
$2K |
| D2394 |
|
22 |
12 |
$2K |
| D4342 |
|
38 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$726.00 |