| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,843 |
1,366 |
$375K |
| D2740 |
Crown - porcelain/ceramic |
522 |
417 |
$223K |
| D0330 |
Panoramic radiographic image |
2,990 |
2,970 |
$153K |
| D7240 |
Removal of impacted tooth - completely bony |
529 |
168 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,397 |
3,380 |
$131K |
| D1110 |
Prophylaxis - adult |
2,495 |
2,465 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,531 |
3,504 |
$103K |
| D9243 |
|
350 |
350 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
517 |
249 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
439 |
277 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
568 |
352 |
$58K |
| D2950 |
|
338 |
262 |
$40K |
| D9239 |
|
351 |
351 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,425 |
1,403 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
897 |
883 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,266 |
2,221 |
$28K |
| D1206 |
Topical application of fluoride varnish |
665 |
656 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
2,395 |
2,386 |
$10K |
| D4346 |
|
218 |
218 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
771 |
761 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
24 |
$8K |
| D7230 |
|
33 |
15 |
$7K |
| D1120 |
Prophylaxis - child |
129 |
125 |
$4K |
| D2331 |
|
27 |
14 |
$3K |
| D4342 |
|
38 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$751.92 |