| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,378 |
1,387 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,319 |
2,306 |
$147K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
205 |
169 |
$96K |
| D1120 |
Prophylaxis - child |
2,022 |
2,002 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,235 |
1,231 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,255 |
682 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,475 |
2,850 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,325 |
1,313 |
$62K |
| D0350 |
|
5,830 |
2,419 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,016 |
2,991 |
$38K |
| D1110 |
Prophylaxis - adult |
354 |
353 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
282 |
193 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
1,022 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
172 |
90 |
$20K |
| D2954 |
|
138 |
113 |
$14K |
| D9430 |
|
440 |
430 |
$13K |
| D0330 |
Panoramic radiographic image |
392 |
391 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
24 |
$11K |
| D0272 |
Bitewings - two radiographic images |
694 |
689 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
44 |
$6K |
| D7230 |
|
18 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
152 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
164 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$2K |