| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,022 |
592 |
$311K |
| D1110 |
Prophylaxis - adult |
3,613 |
3,562 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,181 |
3,139 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
811 |
484 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,717 |
2,075 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,734 |
1,710 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
641 |
623 |
$16K |
| D2950 |
|
272 |
173 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
435 |
420 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
238 |
139 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,756 |
2,674 |
$11K |
| D9920 |
|
540 |
523 |
$9K |
| D2954 |
|
103 |
60 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
559 |
547 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
170 |
165 |
$3K |
| D1120 |
Prophylaxis - child |
124 |
122 |
$2K |
| D4910 |
|
57 |
55 |
$2K |
| D0270 |
|
15 |
12 |
$36.00 |