| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,500 |
1,466 |
$152K |
| D1110 |
Prophylaxis - adult |
3,662 |
3,593 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,205 |
1,177 |
$131K |
| D2740 |
Crown - porcelain/ceramic |
138 |
107 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
5,426 |
5,319 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,226 |
4,172 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,160 |
4,088 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,810 |
2,759 |
$64K |
| D1120 |
Prophylaxis - child |
2,779 |
2,726 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
783 |
390 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,643 |
1,608 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
649 |
459 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
5,781 |
5,234 |
$33K |
| D0330 |
Panoramic radiographic image |
616 |
596 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
745 |
730 |
$20K |
| D2954 |
|
62 |
49 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,172 |
1,158 |
$13K |
| D2331 |
|
47 |
25 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
31 |
$3K |
| D2140 |
|
55 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
107 |
25 |
$2K |
| D2160 |
|
22 |
14 |
$1K |
| D2332 |
|
18 |
12 |
$1K |
| D2394 |
|
13 |
12 |
$995.02 |