| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,913 |
1,659 |
$251K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
281 |
192 |
$90K |
| D1110 |
Prophylaxis - adult |
4,086 |
4,006 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,198 |
957 |
$85K |
| D2332 |
|
1,705 |
502 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,889 |
3,823 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,175 |
411 |
$39K |
| D0330 |
Panoramic radiographic image |
2,618 |
2,577 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,939 |
1,912 |
$34K |
| D2394 |
|
661 |
342 |
$34K |
| D9911 |
|
14,248 |
2,412 |
$27K |
| D1120 |
Prophylaxis - child |
1,213 |
1,203 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
585 |
269 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
722 |
679 |
$18K |
| D0272 |
Bitewings - two radiographic images |
2,483 |
2,410 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,707 |
2,626 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,163 |
1,154 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,583 |
2,162 |
$8K |
| D2954 |
|
119 |
81 |
$6K |
| D2335 |
|
101 |
50 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
50 |
$4K |
| D2330 |
|
112 |
34 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$3K |
| D9910 |
|
552 |
545 |
$3K |
| D1351 |
Sealant - per tooth |
250 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |