| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,189 |
981 |
$213K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
949 |
503 |
$121K |
| D2740 |
Crown - porcelain/ceramic |
152 |
107 |
$90K |
| D1110 |
Prophylaxis - adult |
1,742 |
1,717 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
908 |
459 |
$73K |
| D0330 |
Panoramic radiographic image |
801 |
794 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,345 |
1,277 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,402 |
1,385 |
$41K |
| D2950 |
|
300 |
232 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,430 |
1,170 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,203 |
1,194 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,877 |
1,709 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
692 |
$20K |
| D4341 |
|
176 |
70 |
$17K |
| D4910 |
|
193 |
193 |
$15K |
| D1120 |
Prophylaxis - child |
397 |
393 |
$15K |
| D4342 |
|
204 |
97 |
$12K |
| D9630 |
|
465 |
461 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
61 |
$9K |
| D1206 |
Topical application of fluoride varnish |
385 |
383 |
$9K |
| D2331 |
|
43 |
25 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
146 |
145 |
$3K |
| D2394 |
|
18 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
87 |
83 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
99 |
$1K |
| D9994 |
|
13 |
13 |
$107.64 |
| D1999 |
|
23 |
15 |
$0.00 |