| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,116 |
541 |
$79K |
| D1110 |
Prophylaxis - adult |
1,555 |
1,393 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,085 |
817 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,538 |
1,399 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
474 |
307 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
451 |
241 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
28 |
23 |
$23K |
| D0274 |
Bitewings - four radiographic images |
937 |
882 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
942 |
816 |
$22K |
| D9944 |
|
105 |
86 |
$19K |
| D0330 |
Panoramic radiographic image |
432 |
415 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
474 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
211 |
84 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,722 |
883 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,452 |
1,235 |
$9K |
| D4342 |
|
117 |
31 |
$7K |
| D2332 |
|
49 |
26 |
$7K |
| D2331 |
|
59 |
26 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
166 |
$4K |
| D1120 |
Prophylaxis - child |
122 |
106 |
$3K |
| D2394 |
|
34 |
27 |
$3K |
| D1320 |
|
97 |
91 |
$2K |
| D0470 |
|
98 |
85 |
$2K |
| D2335 |
|
15 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
71 |
64 |
$1K |
| D0272 |
Bitewings - two radiographic images |
33 |
29 |
$628.80 |
| D1999 |
|
247 |
214 |
$0.00 |
| D1354 |
|
38 |
37 |
$0.00 |