| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,219 |
1,060 |
$165K |
| D2740 |
Crown - porcelain/ceramic |
703 |
345 |
$101K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
645 |
169 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
781 |
408 |
$76K |
| D1110 |
Prophylaxis - adult |
1,937 |
1,890 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,172 |
577 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,960 |
1,754 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,955 |
1,922 |
$40K |
| D2950 |
|
886 |
408 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
2,167 |
2,130 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,725 |
1,713 |
$32K |
| D1120 |
Prophylaxis - child |
884 |
875 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
872 |
831 |
$27K |
| D0330 |
Panoramic radiographic image |
664 |
507 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,230 |
1,081 |
$21K |
| D4342 |
|
148 |
40 |
$9K |
| D4341 |
|
118 |
43 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
748 |
$6K |
| D4910 |
|
243 |
240 |
$4K |
| D2394 |
|
18 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
199 |
112 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
73 |
$2K |
| D3120 |
|
28 |
14 |
$670.04 |