| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,114 |
2,585 |
$679K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,840 |
1,100 |
$301K |
| D0210 |
Intraoral - complete series of radiographic images |
3,788 |
3,733 |
$296K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,300 |
5,230 |
$212K |
| D1110 |
Prophylaxis - adult |
3,528 |
3,480 |
$165K |
| D2740 |
Crown - porcelain/ceramic |
209 |
132 |
$139K |
| D4342 |
|
1,280 |
539 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
4,892 |
4,832 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
985 |
513 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,755 |
2,710 |
$81K |
| D2950 |
|
550 |
381 |
$71K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
386 |
175 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
4,927 |
4,833 |
$61K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
126 |
108 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,385 |
1,357 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,112 |
1,081 |
$37K |
| D2394 |
|
165 |
101 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
39 |
$10K |
| D0460 |
|
279 |
272 |
$8K |
| D4346 |
|
133 |
131 |
$6K |
| D2332 |
|
17 |
12 |
$2K |
| D4910 |
|
12 |
12 |
$2K |