| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,491 |
1,535 |
$151K |
| D1110 |
Prophylaxis - adult |
2,667 |
2,623 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,388 |
3,341 |
$100K |
| D2740 |
Crown - porcelain/ceramic |
214 |
160 |
$99K |
| D4341 |
|
1,343 |
669 |
$98K |
| D0330 |
Panoramic radiographic image |
2,071 |
2,037 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,193 |
868 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,031 |
2,987 |
$76K |
| D1120 |
Prophylaxis - child |
1,105 |
1,092 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
642 |
283 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
969 |
665 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,349 |
1,337 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
177 |
101 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
666 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,540 |
2,566 |
$18K |
| D5212 |
|
29 |
28 |
$16K |
| D2332 |
|
218 |
154 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
703 |
695 |
$10K |
| D2394 |
|
113 |
97 |
$9K |
| D5211 |
|
13 |
13 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,742 |
830 |
$7K |
| D2335 |
|
68 |
41 |
$5K |
| D0272 |
Bitewings - two radiographic images |
238 |
231 |
$4K |
| D2331 |
|
47 |
37 |
$3K |
| D2330 |
|
49 |
25 |
$2K |
| D0270 |
|
357 |
351 |
$2K |