| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,651 |
1,592 |
$308K |
| D2740 |
Crown - porcelain/ceramic |
360 |
253 |
$243K |
| D1110 |
Prophylaxis - adult |
2,979 |
2,976 |
$140K |
| D1120 |
Prophylaxis - child |
3,416 |
3,416 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
5,036 |
5,033 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
807 |
563 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,450 |
4,444 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,804 |
1,803 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
962 |
952 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,510 |
1,466 |
$59K |
| D2950 |
|
283 |
214 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,572 |
1,570 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,721 |
2,584 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
326 |
257 |
$28K |
| D2394 |
|
140 |
107 |
$21K |
| D0272 |
Bitewings - two radiographic images |
773 |
772 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
41 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,258 |
889 |
$12K |
| D0330 |
Panoramic radiographic image |
117 |
117 |
$8K |
| D1351 |
Sealant - per tooth |
281 |
89 |
$7K |
| D2332 |
|
17 |
13 |
$2K |
| D2335 |
|
21 |
12 |
$2K |