| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,341 |
889 |
$156K |
| D1110 |
Prophylaxis - adult |
3,143 |
2,851 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,099 |
623 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
643 |
341 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
500 |
309 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,175 |
1,929 |
$74K |
| D1206 |
Topical application of fluoride varnish |
3,387 |
3,062 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,260 |
2,081 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
863 |
731 |
$46K |
| D2950 |
|
332 |
220 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,054 |
904 |
$36K |
| D0274 |
Bitewings - four radiographic images |
969 |
877 |
$25K |
| D0330 |
Panoramic radiographic image |
459 |
405 |
$22K |
| D2394 |
|
115 |
82 |
$20K |
| D1120 |
Prophylaxis - child |
623 |
570 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
36 |
29 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,011 |
863 |
$15K |
| D2335 |
|
86 |
40 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
64 |
$12K |
| D1351 |
Sealant - per tooth |
427 |
44 |
$9K |
| D4341 |
|
91 |
26 |
$7K |
| D2332 |
|
42 |
27 |
$5K |
| D2331 |
|
53 |
25 |
$4K |
| D2330 |
|
24 |
12 |
$1K |
| D4355 |
|
14 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$133.00 |