| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,958 |
3,405 |
$504K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,621 |
1,876 |
$276K |
| D0210 |
Intraoral - complete series of radiographic images |
4,031 |
3,812 |
$266K |
| D1110 |
Prophylaxis - adult |
5,905 |
5,631 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,165 |
1,246 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
7,099 |
6,766 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,978 |
4,725 |
$143K |
| D2740 |
Crown - porcelain/ceramic |
148 |
65 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,291 |
5,997 |
$110K |
| D0274 |
Bitewings - four radiographic images |
4,485 |
4,292 |
$105K |
| D1120 |
Prophylaxis - child |
4,578 |
4,356 |
$105K |
| D2394 |
|
785 |
479 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,519 |
2,187 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,540 |
4,533 |
$59K |
| D2331 |
|
727 |
428 |
$54K |
| D2335 |
|
310 |
165 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
5,911 |
5,489 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,543 |
2,441 |
$30K |
| D2950 |
|
200 |
107 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
231 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
265 |
123 |
$15K |
| D2332 |
|
144 |
94 |
$14K |
| D2931 |
|
80 |
54 |
$11K |
| D2160 |
|
142 |
71 |
$10K |
| D4341 |
|
54 |
14 |
$5K |
| D0330 |
Panoramic radiographic image |
99 |
93 |
$4K |
| D2161 |
|
45 |
27 |
$4K |
| D1351 |
Sealant - per tooth |
61 |
17 |
$1K |
| D4910 |
|
29 |
26 |
$582.76 |
| D1320 |
|
26 |
26 |
$408.00 |