| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,215 |
1,639 |
$422K |
| D1110 |
Prophylaxis - adult |
4,730 |
4,505 |
$215K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,208 |
3,029 |
$130K |
| D2740 |
Crown - porcelain/ceramic |
227 |
156 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
609 |
389 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,900 |
3,723 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,634 |
2,455 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,270 |
1,181 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
808 |
412 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,408 |
2,295 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
4,962 |
4,544 |
$60K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
328 |
192 |
$50K |
| D4342 |
|
250 |
107 |
$23K |
| D2950 |
|
169 |
110 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
663 |
606 |
$16K |
| D2332 |
|
16 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
17 |
17 |
$523.77 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$148.59 |