| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,783 |
751 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,419 |
658 |
$91K |
| D2740 |
Crown - porcelain/ceramic |
300 |
191 |
$49K |
| D1110 |
Prophylaxis - adult |
1,113 |
1,081 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,534 |
1,297 |
$32K |
| D2950 |
|
355 |
256 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
937 |
916 |
$25K |
| D0330 |
Panoramic radiographic image |
355 |
333 |
$16K |
| D0274 |
Bitewings - four radiographic images |
982 |
953 |
$15K |
| D4341 |
|
672 |
224 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,771 |
1,426 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,199 |
1,163 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$11K |
| D3320 |
|
17 |
12 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
552 |
511 |
$8K |
| D7230 |
|
27 |
12 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
669 |
658 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
16 |
$5K |
| D1120 |
Prophylaxis - child |
350 |
344 |
$4K |
| D2394 |
|
19 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183 |
172 |
$813.68 |
| D4910 |
|
169 |
169 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |