| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,519 |
1,645 |
$338K |
| D1110 |
Prophylaxis - adult |
3,874 |
3,768 |
$195K |
| D1206 |
Topical application of fluoride varnish |
7,021 |
6,839 |
$144K |
| D4910 |
|
2,147 |
2,107 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
5,572 |
5,447 |
$134K |
| D0274 |
Bitewings - four radiographic images |
2,536 |
2,467 |
$85K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
151 |
113 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
736 |
510 |
$50K |
| D1120 |
Prophylaxis - child |
1,410 |
1,377 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,398 |
1,281 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,097 |
1,041 |
$36K |
| D0330 |
Panoramic radiographic image |
635 |
609 |
$32K |
| D1320 |
|
824 |
804 |
$31K |
| D0603 |
|
2,272 |
2,205 |
$24K |
| D2331 |
|
208 |
142 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
90 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
940 |
884 |
$15K |
| D4341 |
|
96 |
43 |
$14K |
| D5214 |
|
12 |
12 |
$12K |
| D4342 |
|
58 |
24 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$3K |
| D1354 |
|
161 |
159 |
$3K |
| D1310 |
|
77 |
77 |
$3K |
| D2330 |
|
38 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
73 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
38 |
$1K |
| D1330 |
|
26 |
26 |
$621.00 |