| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,523 |
1,979 |
$344K |
| D2740 |
Crown - porcelain/ceramic |
343 |
257 |
$224K |
| D0210 |
Intraoral - complete series of radiographic images |
4,802 |
4,721 |
$223K |
| D1110 |
Prophylaxis - adult |
5,468 |
5,441 |
$214K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,697 |
1,058 |
$188K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,135 |
1,252 |
$170K |
| D0140 |
Limited oral evaluation - problem focused |
5,551 |
5,435 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,053 |
1,085 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
6,438 |
6,421 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,241 |
792 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,696 |
3,666 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,835 |
6,515 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
8,866 |
8,633 |
$96K |
| D0274 |
Bitewings - four radiographic images |
3,643 |
3,632 |
$93K |
| D1351 |
Sealant - per tooth |
2,632 |
348 |
$78K |
| D2950 |
|
394 |
307 |
$67K |
| D4342 |
|
949 |
265 |
$66K |
| D4910 |
|
538 |
536 |
$45K |
| D1120 |
Prophylaxis - child |
929 |
927 |
$37K |
| D2394 |
|
188 |
104 |
$30K |
| D4355 |
|
749 |
732 |
$26K |
| D4341 |
|
182 |
57 |
$26K |
| D2332 |
|
287 |
118 |
$22K |
| D1206 |
Topical application of fluoride varnish |
780 |
779 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
743 |
741 |
$16K |
| D0330 |
Panoramic radiographic image |
129 |
129 |
$5K |
| D2330 |
|
62 |
38 |
$3K |
| D2335 |
|
22 |
12 |
$2K |
| D7250 |
|
27 |
13 |
$2K |
| D2331 |
|
14 |
12 |
$562.01 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$295.35 |