| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,009 |
3,896 |
$1.08M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,923 |
3,119 |
$975K |
| D0350 |
|
12,868 |
4,430 |
$962K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,064 |
2,700 |
$533K |
| D2394 |
|
2,418 |
1,534 |
$471K |
| D1110 |
Prophylaxis - adult |
9,236 |
9,075 |
$383K |
| D2332 |
|
1,543 |
925 |
$224K |
| D2331 |
|
1,717 |
989 |
$209K |
| D0274 |
Bitewings - four radiographic images |
6,194 |
6,104 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,578 |
3,551 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
5,920 |
5,850 |
$134K |
| D2740 |
Crown - porcelain/ceramic |
271 |
191 |
$127K |
| D0330 |
Panoramic radiographic image |
2,136 |
2,117 |
$109K |
| D2335 |
|
603 |
386 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,809 |
5,680 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
7,827 |
7,566 |
$96K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
189 |
165 |
$83K |
| D2330 |
|
767 |
481 |
$76K |
| D2950 |
|
405 |
313 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,087 |
1,052 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
1,286 |
1,259 |
$32K |
| D0160 |
|
404 |
402 |
$28K |
| D4342 |
|
189 |
73 |
$18K |
| D1206 |
Topical application of fluoride varnish |
778 |
761 |
$13K |
| D0460 |
|
281 |
279 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
25 |
$7K |
| D4346 |
|
124 |
117 |
$6K |
| D4910 |
|
48 |
48 |
$3K |
| D1120 |
Prophylaxis - child |
65 |
65 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
16 |
$2K |
| D1354 |
|
196 |
55 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$165.75 |