| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,551 |
4,663 |
$1.94M |
| D2740 |
Crown - porcelain/ceramic |
731 |
379 |
$500K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,594 |
1,971 |
$481K |
| D1110 |
Prophylaxis - adult |
8,186 |
7,754 |
$358K |
| D0120 |
Periodic oral evaluation - established patient |
12,756 |
12,109 |
$299K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,134 |
12,216 |
$248K |
| D1120 |
Prophylaxis - child |
5,726 |
5,445 |
$186K |
| D0220 |
Intraoral - periapical first radiographic image |
14,202 |
13,407 |
$175K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,021 |
708 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
2,173 |
2,063 |
$165K |
| D1206 |
Topical application of fluoride varnish |
8,997 |
8,591 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,375 |
3,215 |
$134K |
| D0274 |
Bitewings - four radiographic images |
4,427 |
4,194 |
$128K |
| D4342 |
|
1,040 |
367 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
870 |
485 |
$87K |
| D2950 |
|
515 |
303 |
$69K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
116 |
74 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,359 |
2,256 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,193 |
1,109 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
265 |
137 |
$38K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
110 |
25 |
$18K |
| D0340 |
|
274 |
265 |
$16K |
| D0240 |
|
364 |
361 |
$14K |
| D9310 |
|
261 |
250 |
$11K |
| D4341 |
|
38 |
13 |
$10K |
| D2330 |
|
74 |
37 |
$7K |
| D0350 |
|
232 |
225 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
49 |
48 |
$6K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
38 |
$1K |