| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,084 |
1,097 |
$152K |
| D2740 |
Crown - porcelain/ceramic |
424 |
122 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,442 |
919 |
$104K |
| D0330 |
Panoramic radiographic image |
4,238 |
2,242 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,395 |
485 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,486 |
1,844 |
$51K |
| D1110 |
Prophylaxis - adult |
1,848 |
985 |
$37K |
| D4342 |
|
1,948 |
330 |
$36K |
| D1206 |
Topical application of fluoride varnish |
2,899 |
1,502 |
$31K |
| D0274 |
Bitewings - four radiographic images |
2,698 |
1,426 |
$20K |
| D5140 |
|
45 |
25 |
$17K |
| D5130 |
|
40 |
24 |
$17K |
| D3310 |
|
74 |
25 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,959 |
1,558 |
$14K |
| D1120 |
Prophylaxis - child |
771 |
426 |
$14K |
| D2332 |
|
289 |
97 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
982 |
529 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
302 |
41 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
681 |
360 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
542 |
262 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,679 |
887 |
$6K |
| D2950 |
|
168 |
66 |
$5K |
| D0272 |
Bitewings - two radiographic images |
705 |
383 |
$4K |
| D1351 |
Sealant - per tooth |
236 |
38 |
$4K |
| D2330 |
|
121 |
44 |
$4K |
| D2335 |
|
76 |
24 |
$3K |
| D4341 |
|
57 |
12 |
$3K |
| D4355 |
|
84 |
43 |
$2K |
| D2394 |
|
27 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
15 |
$254.56 |