| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,942 |
1,499 |
$395K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,019 |
628 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,891 |
3,884 |
$148K |
| D1110 |
Prophylaxis - adult |
3,442 |
3,432 |
$144K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,492 |
652 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
1,484 |
1,472 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
3,003 |
2,937 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,645 |
7,509 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,664 |
4,627 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,624 |
3,613 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,152 |
2,150 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
113 |
$21K |
| D2394 |
|
50 |
42 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$5K |
| D2950 |
|
15 |
13 |
$2K |
| D0270 |
|
13 |
13 |
$163.28 |