| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,845 |
2,010 |
$412K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,468 |
1,323 |
$180K |
| D1110 |
Prophylaxis - adult |
2,795 |
2,783 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,434 |
4,414 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
4,765 |
4,740 |
$78K |
| D1120 |
Prophylaxis - child |
2,376 |
2,365 |
$70K |
| D9630 |
|
3,825 |
3,806 |
$64K |
| D2740 |
Crown - porcelain/ceramic |
148 |
126 |
$44K |
| D9920 |
|
717 |
664 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
756 |
473 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
1,096 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,281 |
1,267 |
$25K |
| D2332 |
|
188 |
99 |
$23K |
| D0272 |
Bitewings - two radiographic images |
954 |
948 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
25 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
447 |
384 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,044 |
961 |
$7K |
| D0330 |
Panoramic radiographic image |
169 |
154 |
$7K |
| D4355 |
|
81 |
80 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
27 |
$446.94 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
87 |
$393.48 |
| D2394 |
|
17 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$0.00 |