| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,870 |
3,444 |
$1.02M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,275 |
1,231 |
$580K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,326 |
1,813 |
$514K |
| D2740 |
Crown - porcelain/ceramic |
728 |
419 |
$414K |
| D1110 |
Prophylaxis - adult |
5,008 |
4,839 |
$222K |
| D0140 |
Limited oral evaluation - problem focused |
5,833 |
5,746 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,378 |
4,245 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
2,181 |
2,108 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
5,315 |
5,158 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
8,996 |
8,735 |
$109K |
| D2394 |
|
579 |
376 |
$107K |
| D0460 |
|
3,524 |
3,514 |
$92K |
| D2950 |
|
719 |
469 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,035 |
2,985 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
831 |
465 |
$84K |
| D3320 |
|
203 |
188 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,509 |
2,211 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
314 |
181 |
$48K |
| D2331 |
|
258 |
184 |
$31K |
| D3348 |
|
54 |
54 |
$27K |
| D2332 |
|
189 |
56 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
55 |
$15K |
| D0270 |
|
1,147 |
1,145 |
$15K |
| D4342 |
|
95 |
37 |
$12K |
| D2335 |
|
67 |
13 |
$8K |
| D4341 |
|
24 |
12 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
29 |
$6K |
| D4355 |
|
13 |
13 |
$974.16 |