| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,113 |
2,243 |
$298K |
| D1110 |
Prophylaxis - adult |
4,257 |
4,193 |
$175K |
| D2740 |
Crown - porcelain/ceramic |
392 |
304 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
6,162 |
6,089 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,076 |
2,052 |
$109K |
| D1120 |
Prophylaxis - child |
2,865 |
2,847 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,314 |
796 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
796 |
530 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,838 |
2,729 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,148 |
2,117 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
522 |
286 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,746 |
5,551 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,182 |
2,135 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,258 |
2,251 |
$34K |
| D1351 |
Sealant - per tooth |
1,450 |
271 |
$27K |
| D2954 |
|
218 |
174 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
41 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
45 |
40 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,903 |
3,117 |
$16K |
| D4341 |
|
153 |
57 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,052 |
1,051 |
$13K |
| D9310 |
|
513 |
475 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
740 |
700 |
$9K |
| D0330 |
Panoramic radiographic image |
125 |
125 |
$5K |
| D0270 |
|
311 |
300 |
$2K |
| D2950 |
|
33 |
27 |
$2K |
| D0603 |
|
185 |
185 |
$2K |
| D1206 |
Topical application of fluoride varnish |
291 |
291 |
$2K |
| D4910 |
|
24 |
24 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
15 |
$1K |
| D0602 |
|
12 |
12 |
$120.00 |