| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,165 |
666 |
$113K |
| D9920 |
|
2,245 |
2,161 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,407 |
764 |
$78K |
| D1110 |
Prophylaxis - adult |
2,527 |
2,508 |
$72K |
| D2740 |
Crown - porcelain/ceramic |
353 |
237 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,779 |
3,751 |
$47K |
| D1120 |
Prophylaxis - child |
2,010 |
1,994 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,185 |
3,162 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
603 |
364 |
$33K |
| D9630 |
|
2,630 |
2,608 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,184 |
1,113 |
$26K |
| D2332 |
|
251 |
140 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,523 |
1,506 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,328 |
1,268 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
827 |
804 |
$23K |
| D2954 |
|
305 |
230 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
403 |
255 |
$20K |
| D3120 |
|
952 |
460 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
817 |
$16K |
| D0272 |
Bitewings - two radiographic images |
973 |
967 |
$12K |
| D0330 |
Panoramic radiographic image |
232 |
231 |
$9K |
| D2394 |
|
51 |
38 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
869 |
828 |
$7K |
| D3221 |
|
15 |
12 |
$965.14 |
| D4341 |
|
38 |
16 |
$0.00 |