| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,484 |
3,881 |
$499K |
| D1110 |
Prophylaxis - adult |
7,111 |
6,927 |
$280K |
| D0330 |
Panoramic radiographic image |
4,657 |
4,524 |
$253K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,542 |
2,025 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,479 |
6,296 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,201 |
1,444 |
$185K |
| D0274 |
Bitewings - four radiographic images |
9,484 |
9,186 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
7,274 |
7,116 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,951 |
896 |
$137K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,320 |
6,417 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,370 |
4,283 |
$76K |
| D1120 |
Prophylaxis - child |
2,337 |
2,290 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
7,647 |
7,404 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
2,581 |
2,051 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,412 |
1,365 |
$43K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
52 |
50 |
$38K |
| D2332 |
|
231 |
93 |
$29K |
| D2335 |
|
155 |
99 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
17 |
13 |
$14K |
| D0240 |
|
739 |
381 |
$10K |
| D2950 |
|
68 |
51 |
$10K |
| D4342 |
|
101 |
30 |
$10K |
| D1351 |
Sealant - per tooth |
263 |
52 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
98 |
57 |
$5K |
| D0272 |
Bitewings - two radiographic images |
460 |
452 |
$5K |
| D2394 |
|
41 |
28 |
$3K |
| D2160 |
|
31 |
24 |
$2K |
| D2331 |
|
23 |
12 |
$1K |