| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,144 |
2,965 |
$690K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,673 |
2,067 |
$536K |
| D2740 |
Crown - porcelain/ceramic |
1,004 |
811 |
$446K |
| D1110 |
Prophylaxis - adult |
9,218 |
9,087 |
$394K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,245 |
1,508 |
$359K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,762 |
1,411 |
$288K |
| D0210 |
Intraoral - complete series of radiographic images |
3,001 |
2,929 |
$225K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,307 |
5,228 |
$203K |
| D0120 |
Periodic oral evaluation - established patient |
8,387 |
8,260 |
$191K |
| D0274 |
Bitewings - four radiographic images |
5,870 |
5,789 |
$169K |
| D0140 |
Limited oral evaluation - problem focused |
2,797 |
2,745 |
$93K |
| D1206 |
Topical application of fluoride varnish |
4,367 |
4,312 |
$78K |
| D2950 |
|
489 |
439 |
$61K |
| D2332 |
|
384 |
229 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,102 |
3,957 |
$49K |
| D1120 |
Prophylaxis - child |
1,379 |
1,354 |
$43K |
| D4910 |
|
504 |
488 |
$35K |
| D0330 |
Panoramic radiographic image |
608 |
603 |
$30K |
| D1351 |
Sealant - per tooth |
882 |
225 |
$30K |
| D2394 |
|
58 |
41 |
$11K |
| D0160 |
|
85 |
85 |
$6K |
| D2331 |
|
37 |
26 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
356 |
335 |
$4K |
| D2335 |
|
16 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
77 |
53 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$2K |
| D0460 |
|
36 |
36 |
$966.24 |