| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,122 |
1,130 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,400 |
1,193 |
$149K |
| D1110 |
Prophylaxis - adult |
3,297 |
3,199 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,108 |
775 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
3,458 |
2,702 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
3,261 |
3,206 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,703 |
2,671 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,144 |
2,102 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,175 |
1,819 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
5,571 |
4,581 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,251 |
2,747 |
$42K |
| D2950 |
|
412 |
325 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
877 |
841 |
$40K |
| D1120 |
Prophylaxis - child |
1,247 |
1,239 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
334 |
154 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
191 |
115 |
$19K |
| D9630 |
|
701 |
686 |
$13K |
| D7250 |
|
135 |
53 |
$12K |
| D9994 |
|
1,584 |
1,577 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
25 |
$9K |
| D4355 |
|
14 |
14 |
$1K |
| D3120 |
|
177 |
59 |
$0.00 |
| D2335 |
|
23 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
81 |
$0.00 |
| D2332 |
|
161 |
50 |
$0.00 |