| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,285 |
1,277 |
$311K |
| D0210 |
Intraoral - complete series of radiographic images |
2,322 |
2,308 |
$186K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,001 |
598 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,964 |
3,939 |
$159K |
| D1110 |
Prophylaxis - adult |
3,451 |
3,424 |
$157K |
| D2740 |
Crown - porcelain/ceramic |
235 |
139 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
3,726 |
3,701 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
2,347 |
2,335 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
798 |
394 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,429 |
2,421 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
5,065 |
5,001 |
$63K |
| D2950 |
|
393 |
264 |
$51K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
71 |
57 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
117 |
62 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,169 |
1,160 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
78 |
$14K |
| D4341 |
|
34 |
13 |
$4K |
| D0270 |
|
88 |
88 |
$1K |