| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,925 |
3,714 |
$477K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,272 |
2,567 |
$297K |
| D1110 |
Prophylaxis - adult |
6,338 |
5,786 |
$220K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,244 |
1,768 |
$211K |
| D0330 |
Panoramic radiographic image |
5,209 |
4,761 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,143 |
6,592 |
$186K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,331 |
1,403 |
$178K |
| D0274 |
Bitewings - four radiographic images |
10,370 |
9,546 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
5,166 |
4,726 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
10,817 |
9,827 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,043 |
1,008 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,732 |
8,699 |
$43K |
| D1120 |
Prophylaxis - child |
1,773 |
1,682 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,244 |
2,120 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
27 |
13 |
$22K |
| D0240 |
|
2,152 |
972 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
908 |
856 |
$18K |
| D2335 |
|
168 |
92 |
$14K |
| D2394 |
|
193 |
136 |
$13K |
| D2331 |
|
147 |
80 |
$9K |
| D2330 |
|
199 |
99 |
$8K |
| D4341 |
|
92 |
36 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
31 |
$3K |
| D2950 |
|
19 |
13 |
$3K |
| D1320 |
|
72 |
65 |
$2K |
| D2140 |
|
49 |
26 |
$2K |
| D2332 |
|
22 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
79 |
19 |
$1K |
| D0272 |
Bitewings - two radiographic images |
106 |
102 |
$720.00 |