| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,042 |
2,579 |
$310K |
| D2740 |
Crown - porcelain/ceramic |
381 |
257 |
$303K |
| D1110 |
Prophylaxis - adult |
5,156 |
5,063 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
7,938 |
7,826 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,882 |
4,808 |
$155K |
| D1206 |
Topical application of fluoride varnish |
7,989 |
7,891 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,461 |
1,520 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
1,856 |
1,789 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,845 |
475 |
$129K |
| D1120 |
Prophylaxis - child |
5,579 |
5,514 |
$129K |
| D0274 |
Bitewings - four radiographic images |
5,118 |
5,045 |
$120K |
| D0330 |
Panoramic radiographic image |
1,843 |
1,812 |
$94K |
| D2950 |
|
671 |
459 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,059 |
693 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,164 |
7,140 |
$74K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
72 |
62 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
7,840 |
7,692 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,517 |
1,490 |
$35K |
| D1351 |
Sealant - per tooth |
888 |
207 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,418 |
1,399 |
$16K |
| D2331 |
|
224 |
149 |
$14K |
| D2332 |
|
163 |
108 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
176 |
91 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
24 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
27 |
$8K |
| D2140 |
|
84 |
45 |
$4K |
| D2160 |
|
28 |
13 |
$2K |
| D2330 |
|
37 |
26 |
$2K |