| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,989 |
1,053 |
$299K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,688 |
1,114 |
$286K |
| D1110 |
Prophylaxis - adult |
2,785 |
2,554 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
2,962 |
2,680 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,195 |
1,990 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
3,972 |
3,769 |
$118K |
| D1120 |
Prophylaxis - child |
2,896 |
2,740 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,487 |
4,267 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,217 |
1,111 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,007 |
907 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,601 |
3,283 |
$27K |
| D1330 |
|
736 |
701 |
$22K |
| D4341 |
|
920 |
163 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
27 |
22 |
$13K |
| D2332 |
|
68 |
39 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,610 |
843 |
$9K |
| D0272 |
Bitewings - two radiographic images |
257 |
243 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
25 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
25 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D2950 |
|
13 |
13 |
$1K |
| D0270 |
|
12 |
12 |
$84.00 |