| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9248 |
|
2,394 |
1,183 |
$382K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,070 |
517 |
$143K |
| D1110 |
Prophylaxis - adult |
1,810 |
1,784 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
2,042 |
1,490 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,398 |
2,363 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
239 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,401 |
2,356 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,066 |
2,033 |
$51K |
| D1120 |
Prophylaxis - child |
718 |
709 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
528 |
518 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,240 |
1,225 |
$29K |
| D0330 |
Panoramic radiographic image |
616 |
602 |
$28K |
| D2750 |
|
48 |
39 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
173 |
65 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
641 |
515 |
$7K |
| D4355 |
|
67 |
67 |
$7K |
| D2332 |
|
47 |
24 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
16 |
15 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$4K |
| D1330 |
|
633 |
615 |
$4K |
| D2940 |
|
36 |
31 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
165 |
152 |
$1K |
| D7510 |
|
16 |
12 |
$768.00 |