| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,216 |
1,887 |
$298K |
| D1110 |
Prophylaxis - adult |
6,368 |
6,082 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
10,713 |
10,273 |
$248K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,958 |
11,506 |
$240K |
| D1120 |
Prophylaxis - child |
7,263 |
6,993 |
$235K |
| D2740 |
Crown - porcelain/ceramic |
453 |
249 |
$214K |
| D0330 |
Panoramic radiographic image |
3,871 |
3,704 |
$159K |
| D0272 |
Bitewings - two radiographic images |
7,055 |
6,754 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,951 |
1,050 |
$115K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
166 |
130 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,735 |
2,608 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
699 |
431 |
$57K |
| D2335 |
|
607 |
221 |
$50K |
| D2950 |
|
415 |
281 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,146 |
1,086 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,807 |
2,542 |
$27K |
| D1351 |
Sealant - per tooth |
830 |
189 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
386 |
164 |
$20K |
| D3320 |
|
40 |
28 |
$16K |
| D1206 |
Topical application of fluoride varnish |
697 |
676 |
$14K |
| D2332 |
|
139 |
76 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,677 |
858 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$7K |