| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,318 |
1,478 |
$310K |
| D2740 |
Crown - porcelain/ceramic |
434 |
354 |
$214K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,022 |
688 |
$107K |
| D1110 |
Prophylaxis - adult |
2,151 |
2,108 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
4,074 |
4,021 |
$100K |
| D4910 |
|
949 |
934 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,639 |
1,611 |
$65K |
| D1120 |
Prophylaxis - child |
1,796 |
1,787 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
377 |
298 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,729 |
2,712 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,831 |
1,796 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,066 |
1,038 |
$37K |
| D2950 |
|
287 |
248 |
$37K |
| D4342 |
|
395 |
151 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,889 |
2,782 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,515 |
1,483 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
119 |
$18K |
| D0272 |
Bitewings - two radiographic images |
700 |
698 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
168 |
168 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
63 |
28 |
$8K |
| D2331 |
|
53 |
38 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
75 |
69 |
$2K |