| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,100 |
2,135 |
$559K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,219 |
727 |
$211K |
| D1110 |
Prophylaxis - adult |
5,008 |
4,983 |
$210K |
| D0210 |
Intraoral - complete series of radiographic images |
3,516 |
3,491 |
$208K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,024 |
651 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,396 |
748 |
$147K |
| D2740 |
Crown - porcelain/ceramic |
245 |
189 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,538 |
3,521 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
5,342 |
5,310 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
651 |
442 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,160 |
3,134 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,839 |
2,826 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,122 |
6,037 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,319 |
2,309 |
$67K |
| D2950 |
|
270 |
236 |
$34K |
| D2331 |
|
51 |
37 |
$6K |
| D4341 |
|
29 |
12 |
$3K |
| D4342 |
|
24 |
12 |
$2K |