| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,606 |
1,995 |
$336K |
| D1110 |
Prophylaxis - adult |
4,046 |
3,983 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,386 |
1,223 |
$153K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,418 |
922 |
$151K |
| D0210 |
Intraoral - complete series of radiographic images |
3,085 |
2,984 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,505 |
735 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,677 |
3,627 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
2,322 |
2,240 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,928 |
2,880 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,195 |
438 |
$50K |
| D1120 |
Prophylaxis - child |
1,158 |
1,157 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,779 |
3,608 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,660 |
1,635 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,231 |
1,230 |
$29K |
| D2740 |
Crown - porcelain/ceramic |
36 |
27 |
$26K |
| D4341 |
|
133 |
52 |
$21K |
| D4355 |
|
305 |
294 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,691 |
2,354 |
$18K |
| D0330 |
Panoramic radiographic image |
406 |
398 |
$13K |
| D2950 |
|
69 |
59 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$9K |
| D2335 |
|
41 |
25 |
$4K |
| D2394 |
|
31 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$1K |