| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,021 |
2,219 |
$296K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,566 |
1,443 |
$296K |
| D2740 |
Crown - porcelain/ceramic |
261 |
121 |
$211K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
484 |
370 |
$193K |
| D1110 |
Prophylaxis - adult |
4,249 |
4,039 |
$156K |
| D2950 |
|
1,446 |
882 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,099 |
4,726 |
$137K |
| D1206 |
Topical application of fluoride varnish |
8,175 |
7,834 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
5,727 |
5,509 |
$105K |
| D1120 |
Prophylaxis - child |
4,538 |
4,361 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,028 |
3,889 |
$82K |
| D2931 |
|
678 |
485 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
3,059 |
2,924 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,448 |
1,180 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
859 |
509 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,007 |
549 |
$54K |
| D2330 |
|
720 |
237 |
$47K |
| D0330 |
Panoramic radiographic image |
878 |
822 |
$47K |
| D1351 |
Sealant - per tooth |
986 |
192 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
7,193 |
6,850 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,410 |
5,414 |
$34K |
| D2140 |
|
426 |
211 |
$17K |
| D3320 |
|
41 |
25 |
$16K |
| D0272 |
Bitewings - two radiographic images |
896 |
894 |
$10K |
| D2160 |
|
139 |
91 |
$9K |
| D4342 |
|
99 |
28 |
$6K |
| D2331 |
|
47 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
299 |
299 |
$4K |
| D2335 |
|
36 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
13 |
$3K |
| D0240 |
|
215 |
108 |
$3K |
| D0270 |
|
87 |
81 |
$435.00 |
| D4910 |
|
12 |
12 |
$375.43 |