| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,700 |
1,992 |
$500K |
| D2740 |
Crown - porcelain/ceramic |
592 |
376 |
$397K |
| D1110 |
Prophylaxis - adult |
4,076 |
4,013 |
$186K |
| D0210 |
Intraoral - complete series of radiographic images |
2,323 |
2,256 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,171 |
4,109 |
$166K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
904 |
600 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,261 |
561 |
$122K |
| D9110 |
|
2,181 |
2,101 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
973 |
529 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,208 |
5,024 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
6,720 |
6,387 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,125 |
2,091 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,306 |
2,265 |
$56K |
| D2394 |
|
150 |
107 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
830 |
802 |
$28K |
| D2950 |
|
202 |
139 |
$26K |
| D2750 |
|
48 |
37 |
$21K |
| D2331 |
|
80 |
51 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
26 |
$9K |
| D4342 |
|
72 |
27 |
$7K |
| D2332 |
|
19 |
13 |
$3K |
| D2335 |
|
15 |
13 |
$3K |