| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,154 |
1,162 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
763 |
529 |
$81K |
| D1110 |
Prophylaxis - adult |
1,979 |
1,950 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,138 |
596 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,508 |
$41K |
| D2950 |
|
499 |
406 |
$39K |
| D2740 |
Crown - porcelain/ceramic |
228 |
168 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,609 |
2,081 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,355 |
3,071 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,187 |
1,171 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
916 |
745 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,269 |
1,259 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
572 |
551 |
$10K |
| D1120 |
Prophylaxis - child |
338 |
337 |
$9K |
| D3320 |
|
13 |
13 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
42 |
$6K |
| D0330 |
Panoramic radiographic image |
183 |
104 |
$6K |
| D4342 |
|
123 |
48 |
$6K |
| D9920 |
|
79 |
66 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
238 |
238 |
$3K |
| D1206 |
Topical application of fluoride varnish |
162 |
153 |
$3K |
| D2332 |
|
16 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |