| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,373 |
1,379 |
$192K |
| D1110 |
Prophylaxis - adult |
3,483 |
3,457 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,387 |
871 |
$123K |
| D0210 |
Intraoral - complete series of radiographic images |
1,638 |
1,616 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,268 |
596 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,201 |
3,185 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,232 |
752 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,616 |
1,598 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,416 |
1,382 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,561 |
3,462 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,693 |
2,632 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,309 |
1,300 |
$32K |
| D2394 |
|
245 |
180 |
$23K |
| D1120 |
Prophylaxis - child |
428 |
428 |
$17K |
| D2335 |
|
191 |
119 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
19 |
12 |
$13K |
| D1206 |
Topical application of fluoride varnish |
366 |
363 |
$9K |
| D4355 |
|
129 |
122 |
$5K |
| D4341 |
|
42 |
14 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
26 |
$3K |
| D2950 |
|
23 |
20 |
$3K |
| D7111 |
|
26 |
12 |
$2K |
| D4346 |
|
18 |
18 |
$1K |
| D2331 |
|
19 |
15 |
$1K |