| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,753 |
965 |
$236K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,102 |
565 |
$210K |
| D0210 |
Intraoral - complete series of radiographic images |
1,478 |
1,465 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
636 |
392 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
952 |
494 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,379 |
2,365 |
$92K |
| D2740 |
Crown - porcelain/ceramic |
123 |
108 |
$56K |
| D1110 |
Prophylaxis - adult |
1,290 |
1,289 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
349 |
132 |
$54K |
| D0274 |
Bitewings - four radiographic images |
886 |
885 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
973 |
973 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
651 |
650 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,124 |
1,113 |
$14K |
| D2950 |
|
66 |
57 |
$8K |
| D4342 |
|
59 |
26 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
135 |
$5K |
| D2331 |
|
35 |
25 |
$4K |
| D2332 |
|
19 |
12 |
$3K |
| D0180 |
|
27 |
27 |
$1K |
| D9110 |
|
15 |
13 |
$779.10 |
| D1206 |
Topical application of fluoride varnish |
31 |
28 |
$522.81 |