| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,654 |
2,858 |
$300K |
| D1110 |
Prophylaxis - adult |
6,590 |
6,584 |
$290K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,322 |
1,941 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
7,080 |
7,071 |
$156K |
| D0272 |
Bitewings - two radiographic images |
7,792 |
7,790 |
$101K |
| D9310 |
|
1,473 |
1,471 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
8,646 |
8,583 |
$92K |
| D2750 |
|
208 |
182 |
$90K |
| D2954 |
|
609 |
576 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,049 |
8,039 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,012 |
847 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,587 |
3,583 |
$40K |
| D9110 |
|
1,557 |
1,557 |
$34K |
| D1120 |
Prophylaxis - child |
937 |
933 |
$31K |
| D2394 |
|
291 |
256 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
43 |
42 |
$19K |
| D2332 |
|
146 |
119 |
$13K |
| D2335 |
|
76 |
52 |
$11K |
| D2331 |
|
71 |
51 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
37 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
13 |
$1K |