| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,340 |
1,244 |
$152K |
| D2740 |
Crown - porcelain/ceramic |
160 |
93 |
$129K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
265 |
252 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,900 |
886 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,124 |
727 |
$87K |
| D1110 |
Prophylaxis - adult |
2,069 |
2,004 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,222 |
543 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,445 |
2,342 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,761 |
2,657 |
$57K |
| D2394 |
|
612 |
452 |
$53K |
| D0330 |
Panoramic radiographic image |
978 |
933 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,764 |
1,735 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,178 |
868 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,625 |
3,452 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,112 |
1,098 |
$21K |
| D0240 |
|
1,309 |
648 |
$19K |
| D1120 |
Prophylaxis - child |
739 |
730 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,228 |
2,857 |
$18K |
| D2140 |
|
141 |
43 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
26 |
$3K |
| D4342 |
|
33 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
65 |
$2K |
| D2330 |
|
31 |
16 |
$2K |