| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,457 |
1,413 |
$142K |
| D2740 |
Crown - porcelain/ceramic |
171 |
92 |
$122K |
| D1110 |
Prophylaxis - adult |
3,309 |
3,276 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,809 |
3,782 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,089 |
1,027 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,479 |
2,456 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
657 |
457 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,380 |
1,356 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,223 |
2,205 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
640 |
485 |
$34K |
| D1120 |
Prophylaxis - child |
1,432 |
1,422 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,054 |
1,017 |
$24K |
| D2950 |
|
89 |
63 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,956 |
1,852 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
95 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
93 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,244 |
711 |
$6K |
| D2394 |
|
76 |
61 |
$6K |
| D0180 |
|
191 |
190 |
$5K |
| D0272 |
Bitewings - two radiographic images |
370 |
366 |
$4K |
| D0350 |
|
128 |
125 |
$3K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
24 |
$2K |
| D1206 |
Topical application of fluoride varnish |
70 |
69 |
$2K |
| D2331 |
|
17 |
14 |
$1K |
| D2140 |
|
17 |
12 |
$680.00 |