| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,113 |
3,083 |
$429K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,653 |
2,540 |
$352K |
| D2740 |
Crown - porcelain/ceramic |
414 |
306 |
$276K |
| D1110 |
Prophylaxis - adult |
6,574 |
6,515 |
$245K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,024 |
1,393 |
$199K |
| D0140 |
Limited oral evaluation - problem focused |
7,212 |
7,053 |
$191K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,530 |
1,532 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
4,264 |
4,152 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,683 |
1,722 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,532 |
5,489 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
6,267 |
6,233 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
10,779 |
10,425 |
$105K |
| D0274 |
Bitewings - four radiographic images |
4,369 |
4,337 |
$102K |
| D2950 |
|
562 |
442 |
$97K |
| D0330 |
Panoramic radiographic image |
2,127 |
2,119 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,561 |
5,982 |
$57K |
| D4341 |
|
333 |
134 |
$49K |
| D5110 |
|
65 |
65 |
$37K |
| D1120 |
Prophylaxis - child |
908 |
908 |
$36K |
| D4355 |
|
505 |
504 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,135 |
1,134 |
$24K |
| D2332 |
|
232 |
155 |
$17K |
| D2394 |
|
138 |
105 |
$15K |
| D5120 |
|
25 |
25 |
$11K |
| D2331 |
|
154 |
108 |
$9K |
| D1351 |
Sealant - per tooth |
277 |
26 |
$9K |
| D2335 |
|
94 |
68 |
$8K |
| D5213 |
|
14 |
14 |
$7K |
| D2330 |
|
153 |
100 |
$7K |
| D0272 |
Bitewings - two radiographic images |
223 |
221 |
$4K |
| D4910 |
|
38 |
38 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
125 |
125 |
$3K |
| D0270 |
|
342 |
339 |
$3K |
| D4346 |
|
24 |
24 |
$2K |