| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,128 |
5,249 |
$1.02M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,082 |
5,219 |
$644K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
573 |
392 |
$220K |
| D1110 |
Prophylaxis - adult |
6,274 |
6,268 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
9,350 |
9,341 |
$181K |
| D0274 |
Bitewings - four radiographic images |
6,030 |
6,030 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
10,156 |
10,119 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,109 |
9,100 |
$69K |
| D1120 |
Prophylaxis - child |
1,522 |
1,521 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
2,294 |
2,282 |
$45K |
| D2331 |
|
584 |
362 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
596 |
595 |
$11K |
| D0272 |
Bitewings - two radiographic images |
873 |
873 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
137 |
$8K |
| D9110 |
|
530 |
529 |
$7K |
| D2954 |
|
50 |
48 |
$5K |
| D4341 |
|
138 |
51 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$976.44 |
| D0330 |
Panoramic radiographic image |
22 |
22 |
$613.26 |