| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,209 |
2,338 |
$530K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,620 |
1,366 |
$141K |
| D1110 |
Prophylaxis - adult |
3,505 |
3,409 |
$122K |
| D2332 |
|
1,453 |
483 |
$110K |
| D0240 |
|
9,619 |
3,812 |
$95K |
| D0330 |
Panoramic radiographic image |
2,015 |
1,951 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
4,255 |
4,147 |
$72K |
| D0274 |
Bitewings - four radiographic images |
3,312 |
3,211 |
$67K |
| D1206 |
Topical application of fluoride varnish |
4,010 |
3,902 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,245 |
2,171 |
$59K |
| D1120 |
Prophylaxis - child |
2,645 |
2,583 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,707 |
1,624 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
621 |
401 |
$37K |
| D0272 |
Bitewings - two radiographic images |
2,098 |
2,049 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
16 |
15 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,403 |
1,289 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,016 |
856 |
$5K |
| D2330 |
|
99 |
65 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
36 |
$4K |
| D2335 |
|
22 |
14 |
$2K |