| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,980 |
2,291 |
$434K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,362 |
1,307 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
1,880 |
1,777 |
$147K |
| D1110 |
Prophylaxis - adult |
2,010 |
1,972 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,032 |
1,973 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
913 |
556 |
$61K |
| D2740 |
Crown - porcelain/ceramic |
69 |
51 |
$56K |
| D2331 |
|
521 |
281 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,029 |
2,002 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,370 |
1,271 |
$40K |
| D4341 |
|
210 |
73 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,766 |
1,750 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
405 |
119 |
$33K |
| D2394 |
|
233 |
172 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,226 |
1,530 |
$29K |
| D4342 |
|
209 |
94 |
$25K |
| D2950 |
|
149 |
102 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,011 |
993 |
$20K |
| D0330 |
Panoramic radiographic image |
312 |
296 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,231 |
2,128 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
125 |
60 |
$14K |
| D1120 |
Prophylaxis - child |
426 |
424 |
$11K |
| D2335 |
|
26 |
12 |
$5K |
| D2332 |
|
24 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
216 |
214 |
$3K |
| D1320 |
|
12 |
12 |
$353.76 |
| D0270 |
|
24 |
24 |
$121.00 |