| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,808 |
1,635 |
$381K |
| D2740 |
Crown - porcelain/ceramic |
566 |
462 |
$306K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,358 |
785 |
$225K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,308 |
948 |
$217K |
| D1110 |
Prophylaxis - adult |
4,052 |
3,999 |
$188K |
| D0330 |
Panoramic radiographic image |
3,389 |
3,360 |
$177K |
| D0140 |
Limited oral evaluation - problem focused |
3,259 |
3,114 |
$116K |
| D0350 |
|
2,538 |
2,219 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,707 |
2,679 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,670 |
3,623 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,003 |
646 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,010 |
3,941 |
$98K |
| D2950 |
|
676 |
590 |
$87K |
| D1206 |
Topical application of fluoride varnish |
2,462 |
2,407 |
$47K |
| D4342 |
|
401 |
153 |
$41K |
| D1120 |
Prophylaxis - child |
1,074 |
1,053 |
$35K |
| D0460 |
|
1,127 |
1,082 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
296 |
120 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,198 |
2,122 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
410 |
405 |
$8K |
| D7230 |
|
23 |
14 |
$6K |
| D2394 |
|
15 |
15 |
$3K |
| D4910 |
|
37 |
37 |
$2K |
| D2331 |
|
20 |
12 |
$2K |
| D2330 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$1K |