| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,164 |
675 |
$554K |
| D2954 |
|
1,007 |
625 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,023 |
1,020 |
$65K |
| D1110 |
Prophylaxis - adult |
764 |
757 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
848 |
844 |
$40K |
| D4341 |
|
514 |
135 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
268 |
132 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
490 |
488 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
417 |
240 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
52 |
50 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
166 |
$22K |
| D4910 |
|
239 |
238 |
$18K |
| D1206 |
Topical application of fluoride varnish |
775 |
768 |
$13K |
| D3320 |
|
16 |
12 |
$5K |
| D3221 |
|
47 |
40 |
$3K |
| D9430 |
|
84 |
84 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
168 |
$2K |
| D5850 |
|
24 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
382 |
102 |
$2K |
| D0350 |
|
154 |
147 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |