| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
2,889 |
979 |
$341K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,174 |
1,261 |
$276K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,271 |
1,264 |
$81K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,057 |
461 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,889 |
1,688 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
442 |
282 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,400 |
1,391 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
526 |
524 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
24 |
$16K |
| D2140 |
|
287 |
167 |
$15K |
| D1110 |
Prophylaxis - adult |
159 |
159 |
$13K |
| D2160 |
|
116 |
75 |
$9K |
| D1120 |
Prophylaxis - child |
259 |
259 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
104 |
104 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
24 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$546.00 |