| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,246 |
3,609 |
$754K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,190 |
2,220 |
$283K |
| D2394 |
|
3,416 |
1,804 |
$266K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,200 |
1,931 |
$261K |
| D2335 |
|
2,610 |
1,236 |
$237K |
| D0210 |
Intraoral - complete series of radiographic images |
3,098 |
2,866 |
$176K |
| D1110 |
Prophylaxis - adult |
4,609 |
4,402 |
$166K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,321 |
624 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,853 |
3,663 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
5,603 |
5,365 |
$103K |
| D2740 |
Crown - porcelain/ceramic |
107 |
54 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,103 |
2,951 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,529 |
2,375 |
$63K |
| D0330 |
Panoramic radiographic image |
1,330 |
1,265 |
$56K |
| D2332 |
|
812 |
468 |
$50K |
| D1120 |
Prophylaxis - child |
2,326 |
2,244 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,763 |
2,653 |
$45K |
| D2950 |
|
342 |
195 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
560 |
136 |
$30K |
| D4341 |
|
270 |
126 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,045 |
2,784 |
$18K |
| D2161 |
|
159 |
80 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,249 |
832 |
$12K |
| D2330 |
|
248 |
120 |
$11K |
| D2160 |
|
140 |
73 |
$9K |
| D0272 |
Bitewings - two radiographic images |
432 |
422 |
$4K |
| D2140 |
|
49 |
24 |
$2K |
| D2331 |
|
30 |
24 |
$2K |
| D1351 |
Sealant - per tooth |
51 |
12 |
$1K |
| D1999 |
|
50 |
46 |
$0.00 |