| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,189 |
1,605 |
$325K |
| D2740 |
Crown - porcelain/ceramic |
552 |
330 |
$309K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,932 |
1,060 |
$243K |
| D1110 |
Prophylaxis - adult |
3,709 |
3,691 |
$170K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,890 |
982 |
$143K |
| D0330 |
Panoramic radiographic image |
2,634 |
2,614 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
4,464 |
4,438 |
$113K |
| D1120 |
Prophylaxis - child |
2,534 |
2,527 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,588 |
2,571 |
$89K |
| D2950 |
|
582 |
370 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,307 |
2,275 |
$80K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
149 |
143 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,838 |
2,812 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
3,836 |
3,759 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,873 |
1,868 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
744 |
313 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,014 |
2,540 |
$22K |
| D4355 |
|
412 |
393 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
350 |
$19K |
| D0272 |
Bitewings - two radiographic images |
545 |
545 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
71 |
$7K |
| D3320 |
|
16 |
13 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
286 |
286 |
$7K |
| D7111 |
|
88 |
63 |
$6K |
| D1351 |
Sealant - per tooth |
92 |
12 |
$2K |