| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,710 |
1,325 |
$369K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,231 |
709 |
$201K |
| D1110 |
Prophylaxis - adult |
2,360 |
2,355 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,434 |
3,420 |
$80K |
| D2332 |
|
454 |
150 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
149 |
128 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,197 |
2,193 |
$64K |
| D0330 |
Panoramic radiographic image |
1,164 |
1,160 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,508 |
1,500 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,338 |
2,254 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
148 |
$28K |
| D1120 |
Prophylaxis - child |
593 |
586 |
$19K |
| D4910 |
|
245 |
236 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
830 |
819 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
49 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
690 |
686 |
$9K |
| D1206 |
Topical application of fluoride varnish |
429 |
429 |
$8K |
| D2950 |
|
47 |
40 |
$6K |
| D2954 |
|
40 |
39 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
234 |
227 |
$4K |
| D9110 |
|
56 |
56 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
70 |
$2K |
| D0460 |
|
13 |
13 |
$311.31 |