| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,193 |
1,085 |
$165K |
| D1110 |
Prophylaxis - adult |
3,102 |
3,038 |
$115K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
485 |
214 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
789 |
365 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
654 |
414 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,922 |
2,828 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,433 |
2,373 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,991 |
1,772 |
$50K |
| D9992 |
|
6,662 |
5,443 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,481 |
2,420 |
$39K |
| D1120 |
Prophylaxis - child |
934 |
892 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,538 |
1,325 |
$29K |
| D0330 |
Panoramic radiographic image |
482 |
470 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,562 |
2,056 |
$20K |
| D9920 |
|
279 |
234 |
$19K |
| D2394 |
|
46 |
38 |
$7K |
| D2950 |
|
69 |
57 |
$5K |
| D4341 |
|
66 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
352 |
215 |
$2K |
| D2740 |
Crown - porcelain/ceramic |
14 |
13 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
13 |
13 |
$0.00 |