| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,786 |
1,194 |
$182K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,403 |
726 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,726 |
610 |
$114K |
| D1110 |
Prophylaxis - adult |
2,273 |
2,217 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,161 |
534 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,354 |
2,298 |
$67K |
| D0330 |
Panoramic radiographic image |
1,151 |
1,117 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,713 |
2,642 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,755 |
1,725 |
$38K |
| D2335 |
|
206 |
103 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,844 |
3,753 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,523 |
3,426 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
565 |
561 |
$17K |
| D1120 |
Prophylaxis - child |
552 |
550 |
$14K |
| D2394 |
|
133 |
100 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
27 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
490 |
489 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
61 |
$8K |
| D1320 |
|
284 |
276 |
$8K |
| D0240 |
|
533 |
273 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
201 |
$5K |
| D3320 |
|
15 |
15 |
$4K |
| D2160 |
|
46 |
29 |
$3K |
| D2332 |
|
24 |
12 |
$2K |
| D2140 |
|
42 |
25 |
$2K |