| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,047 |
1,893 |
$540K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,198 |
1,238 |
$354K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,423 |
697 |
$218K |
| D4342 |
|
1,883 |
730 |
$170K |
| D2394 |
|
887 |
618 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,251 |
3,216 |
$127K |
| D2740 |
Crown - porcelain/ceramic |
184 |
103 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,971 |
1,930 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
944 |
492 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,094 |
3,031 |
$81K |
| D2950 |
|
513 |
352 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,693 |
1,611 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,422 |
4,300 |
$55K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
110 |
75 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,402 |
1,391 |
$42K |
| D2335 |
|
175 |
77 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,023 |
1,018 |
$25K |
| D3320 |
|
43 |
38 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$12K |
| D1110 |
Prophylaxis - adult |
270 |
268 |
$12K |
| D0460 |
|
184 |
174 |
$5K |
| D4910 |
|
30 |
29 |
$2K |
| D1206 |
Topical application of fluoride varnish |
50 |
48 |
$906.82 |