| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,114 |
2,035 |
$549K |
| D2740 |
Crown - porcelain/ceramic |
429 |
191 |
$306K |
| D1110 |
Prophylaxis - adult |
6,411 |
6,308 |
$281K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,099 |
703 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
6,491 |
6,385 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,476 |
3,405 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,132 |
449 |
$119K |
| D0274 |
Bitewings - four radiographic images |
4,032 |
3,989 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,204 |
1,181 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
1,572 |
1,537 |
$55K |
| D2950 |
|
352 |
165 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,261 |
3,180 |
$40K |
| D4342 |
|
407 |
156 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
142 |
67 |
$21K |
| D2332 |
|
121 |
67 |
$18K |
| D1206 |
Topical application of fluoride varnish |
857 |
829 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
12 |
$6K |
| D2335 |
|
24 |
12 |
$4K |
| D2394 |
|
21 |
15 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
208 |
$4K |
| D1120 |
Prophylaxis - child |
71 |
68 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
13 |
$2K |
| D4910 |
|
12 |
12 |
$800.88 |