| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,867 |
1,315 |
$371K |
| D2740 |
Crown - porcelain/ceramic |
268 |
155 |
$219K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,858 |
801 |
$188K |
| D4342 |
|
1,619 |
622 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,748 |
1,698 |
$70K |
| D0350 |
|
1,368 |
1,274 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
938 |
921 |
$45K |
| D0460 |
|
1,658 |
1,561 |
$43K |
| D2950 |
|
261 |
152 |
$34K |
| D0330 |
Panoramic radiographic image |
588 |
568 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
127 |
41 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
739 |
695 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,451 |
1,343 |
$17K |
| D0274 |
Bitewings - four radiographic images |
618 |
591 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
66 |
$14K |
| D4346 |
|
293 |
289 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
306 |
$11K |
| D1110 |
Prophylaxis - adult |
101 |
101 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
553 |
474 |
$9K |
| D1206 |
Topical application of fluoride varnish |
132 |
132 |
$5K |
| D4910 |
|
13 |
13 |
$849.16 |