| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,058 |
2,301 |
$544K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,077 |
771 |
$205K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,135 |
696 |
$180K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,040 |
699 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
1,986 |
1,951 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,802 |
3,747 |
$154K |
| D1110 |
Prophylaxis - adult |
3,175 |
3,135 |
$144K |
| D2740 |
Crown - porcelain/ceramic |
187 |
113 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
2,447 |
2,418 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,709 |
1,649 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
512 |
344 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,980 |
2,906 |
$37K |
| D0274 |
Bitewings - four radiographic images |
690 |
686 |
$21K |
| D2950 |
|
123 |
72 |
$16K |
| D2331 |
|
107 |
68 |
$13K |
| D2750 |
|
21 |
12 |
$9K |
| D0160 |
|
156 |
155 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
190 |
188 |
$4K |
| D1120 |
Prophylaxis - child |
87 |
80 |
$3K |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$901.71 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$669.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$162.24 |