| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,068 |
484 |
$166K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
680 |
194 |
$146K |
| D2740 |
Crown - porcelain/ceramic |
184 |
161 |
$127K |
| D0330 |
Panoramic radiographic image |
1,434 |
1,340 |
$125K |
| D0220 |
Intraoral - periapical first radiographic image |
5,215 |
4,140 |
$116K |
| D1110 |
Prophylaxis - adult |
1,261 |
1,159 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,872 |
2,505 |
$94K |
| D0274 |
Bitewings - four radiographic images |
1,685 |
1,538 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,492 |
1,359 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
1,215 |
1,128 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
553 |
282 |
$65K |
| D2330 |
|
206 |
101 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
125 |
74 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
533 |
507 |
$22K |
| D5214 |
|
16 |
14 |
$12K |
| D1206 |
Topical application of fluoride varnish |
484 |
449 |
$12K |
| D2950 |
|
57 |
49 |
$9K |
| D1351 |
Sealant - per tooth |
189 |
27 |
$8K |
| D2331 |
|
27 |
18 |
$3K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$2K |
| D4355 |
|
13 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
29 |
$2K |
| D0350 |
|
15 |
15 |
$0.00 |