| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,937 |
2,176 |
$224K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,234 |
998 |
$186K |
| D1110 |
Prophylaxis - adult |
4,281 |
4,147 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,184 |
1,315 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,784 |
1,552 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,652 |
3,513 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
5,025 |
4,883 |
$95K |
| D0274 |
Bitewings - four radiographic images |
4,103 |
3,958 |
$89K |
| D0330 |
Panoramic radiographic image |
1,575 |
1,499 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,100 |
6,325 |
$74K |
| D2332 |
|
808 |
416 |
$71K |
| D1120 |
Prophylaxis - child |
2,695 |
2,629 |
$58K |
| D1206 |
Topical application of fluoride varnish |
3,363 |
3,285 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
8,411 |
7,907 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,917 |
1,834 |
$46K |
| D2394 |
|
351 |
229 |
$26K |
| D2740 |
Crown - porcelain/ceramic |
32 |
25 |
$25K |
| D2335 |
|
176 |
110 |
$18K |
| D2330 |
|
267 |
172 |
$14K |
| D0272 |
Bitewings - two radiographic images |
901 |
881 |
$10K |
| D0350 |
|
406 |
387 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
344 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
185 |
158 |
$6K |
| D2331 |
|
101 |
68 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
36 |
$4K |
| D2950 |
|
36 |
26 |
$3K |
| D0180 |
|
32 |
31 |
$949.45 |
| D2140 |
|
17 |
14 |
$680.00 |
| D1320 |
|
12 |
12 |
$180.00 |