| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,325 |
1,154 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,820 |
948 |
$122K |
| D0330 |
Panoramic radiographic image |
2,194 |
2,038 |
$104K |
| D1110 |
Prophylaxis - adult |
1,949 |
1,819 |
$69K |
| D2394 |
|
742 |
487 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
3,165 |
3,011 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,608 |
2,467 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,983 |
1,826 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
547 |
184 |
$32K |
| D8670 |
Periodic orthodontic treatment visit |
85 |
85 |
$26K |
| D2332 |
|
305 |
146 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
239 |
155 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
164 |
82 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
20 |
12 |
$9K |
| D1206 |
Topical application of fluoride varnish |
589 |
553 |
$9K |
| D2160 |
|
131 |
75 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
315 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
14 |
$7K |
| D1120 |
Prophylaxis - child |
323 |
308 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,216 |
1,125 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
351 |
$6K |
| D2335 |
|
50 |
39 |
$5K |
| D8030 |
|
54 |
54 |
$4K |
| D0340 |
|
45 |
44 |
$2K |
| D0180 |
|
59 |
59 |
$2K |
| D2950 |
|
15 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
110 |
$664.20 |
| D0350 |
|
17 |
16 |
$189.56 |
| D0272 |
Bitewings - two radiographic images |
24 |
15 |
$175.80 |