| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,813 |
2,989 |
$309K |
| D1110 |
Prophylaxis - adult |
5,977 |
5,774 |
$210K |
| D0210 |
Intraoral - complete series of radiographic images |
2,878 |
2,707 |
$181K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,090 |
1,543 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,093 |
1,394 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
6,206 |
6,035 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,704 |
3,615 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,408 |
620 |
$82K |
| D0274 |
Bitewings - four radiographic images |
3,270 |
3,163 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,477 |
2,381 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
75 |
61 |
$61K |
| D0330 |
Panoramic radiographic image |
1,112 |
1,094 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,650 |
2,584 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,607 |
3,430 |
$22K |
| D1120 |
Prophylaxis - child |
1,075 |
1,055 |
$22K |
| D2950 |
|
226 |
208 |
$19K |
| D2332 |
|
198 |
106 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
30 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,608 |
1,079 |
$11K |
| D2331 |
|
155 |
93 |
$9K |
| D2394 |
|
73 |
61 |
$7K |
| D2330 |
|
110 |
77 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
73 |
36 |
$4K |
| D2335 |
|
33 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
182 |
182 |
$2K |
| D0350 |
|
56 |
51 |
$677.05 |
| D4910 |
|
12 |
12 |
$409.56 |
| D0270 |
|
83 |
82 |
$405.50 |
| D1999 |
|
114 |
103 |
$0.00 |