| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,141 |
2,297 |
$687K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,574 |
1,275 |
$373K |
| D2740 |
Crown - porcelain/ceramic |
523 |
374 |
$299K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,638 |
895 |
$264K |
| D2332 |
|
1,586 |
542 |
$237K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,069 |
5,039 |
$196K |
| D0210 |
Intraoral - complete series of radiographic images |
2,282 |
2,263 |
$178K |
| D1110 |
Prophylaxis - adult |
3,110 |
3,092 |
$134K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
663 |
386 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,693 |
2,656 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,432 |
2,429 |
$57K |
| D2950 |
|
426 |
303 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,372 |
4,319 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,365 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
394 |
137 |
$37K |
| D2331 |
|
216 |
87 |
$26K |
| D2335 |
|
123 |
66 |
$20K |
| D2394 |
|
42 |
26 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
262 |
258 |
$7K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$831.87 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$410.16 |