| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,522 |
1,241 |
$231K |
| D1110 |
Prophylaxis - adult |
3,994 |
3,916 |
$217K |
| D0274 |
Bitewings - four radiographic images |
4,748 |
4,625 |
$173K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,972 |
735 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,524 |
4,404 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
6,649 |
6,348 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,005 |
5,240 |
$92K |
| D1120 |
Prophylaxis - child |
1,826 |
1,769 |
$91K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
643 |
401 |
$90K |
| D2740 |
Crown - porcelain/ceramic |
142 |
106 |
$90K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,842 |
2,763 |
$82K |
| D9110 |
|
1,483 |
1,419 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,061 |
1,033 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
868 |
850 |
$38K |
| D2950 |
|
184 |
154 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
222 |
156 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$6K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$962.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$360.00 |