| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,278 |
2,607 |
$582K |
| D2740 |
Crown - porcelain/ceramic |
992 |
702 |
$563K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,775 |
1,117 |
$292K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,469 |
1,323 |
$260K |
| D1110 |
Prophylaxis - adult |
4,743 |
4,677 |
$227K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,210 |
3,164 |
$131K |
| D2950 |
|
907 |
672 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,309 |
3,241 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
1,291 |
1,279 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,386 |
3,342 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,316 |
2,284 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,522 |
5,374 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
162 |
98 |
$27K |
| D2394 |
|
118 |
91 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
42 |
$13K |
| D0330 |
Panoramic radiographic image |
184 |
183 |
$10K |
| D2332 |
|
56 |
45 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
267 |
267 |
$6K |
| D4341 |
|
29 |
12 |
$3K |
| D2335 |
|
16 |
12 |
$3K |
| D2330 |
|
23 |
12 |
$2K |
| D0460 |
|
58 |
56 |
$2K |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$272.82 |