| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,705 |
2,174 |
$490K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,646 |
1,063 |
$261K |
| D0210 |
Intraoral - complete series of radiographic images |
2,149 |
2,133 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,448 |
3,421 |
$135K |
| D1110 |
Prophylaxis - adult |
2,855 |
2,845 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
4,744 |
4,725 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,612 |
2,609 |
$78K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
354 |
206 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,217 |
4,178 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
293 |
$48K |
| D4342 |
|
367 |
174 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
32 |
26 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
689 |
679 |
$23K |
| D2394 |
|
114 |
81 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
781 |
777 |
$22K |
| D2332 |
|
143 |
73 |
$21K |
| D2335 |
|
97 |
51 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
13 |
$7K |
| D2950 |
|
45 |
38 |
$6K |
| D4910 |
|
36 |
36 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |