| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,053 |
5,911 |
$721K |
| D1110 |
Prophylaxis - adult |
18,698 |
18,649 |
$704K |
| D2740 |
Crown - porcelain/ceramic |
1,208 |
800 |
$695K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,426 |
4,350 |
$564K |
| D0120 |
Periodic oral evaluation - established patient |
20,299 |
20,244 |
$446K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,462 |
3,906 |
$337K |
| D0274 |
Bitewings - four radiographic images |
13,266 |
13,220 |
$324K |
| D2394 |
|
2,726 |
2,416 |
$303K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
505 |
492 |
$273K |
| D0140 |
Limited oral evaluation - problem focused |
9,810 |
9,608 |
$259K |
| D2790 |
|
375 |
326 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,915 |
2,169 |
$180K |
| D3320 |
|
389 |
375 |
$170K |
| D1120 |
Prophylaxis - child |
3,547 |
3,540 |
$143K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,963 |
1,683 |
$127K |
| D0220 |
Intraoral - periapical first radiographic image |
12,193 |
11,772 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,457 |
4,447 |
$109K |
| D2950 |
|
742 |
667 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,117 |
3,094 |
$96K |
| D0330 |
Panoramic radiographic image |
2,144 |
2,134 |
$79K |
| D2335 |
|
671 |
518 |
$72K |
| D3310 |
|
173 |
141 |
$69K |
| D2332 |
|
603 |
477 |
$52K |
| D2331 |
|
434 |
352 |
$29K |
| D2752 |
|
52 |
38 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,100 |
1,096 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,046 |
3,252 |
$25K |
| D2330 |
|
313 |
210 |
$16K |
| D2920 |
|
328 |
264 |
$15K |
| D4341 |
|
110 |
28 |
$11K |
| D4355 |
|
204 |
201 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
14 |
$2K |
| D6930 |
|
26 |
25 |
$1K |