| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,753 |
915 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
3,790 |
3,234 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,573 |
1,962 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,573 |
581 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,975 |
3,581 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,631 |
1,408 |
$68K |
| D1110 |
Prophylaxis - adult |
2,450 |
2,176 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,889 |
2,626 |
$62K |
| D1120 |
Prophylaxis - child |
1,586 |
1,438 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,985 |
1,754 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
612 |
345 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,801 |
3,306 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
256 |
$24K |
| D2950 |
|
575 |
245 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
34 |
24 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
79 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,135 |
751 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
21 |
12 |
$6K |
| D0330 |
Panoramic radiographic image |
242 |
138 |
$5K |
| D9310 |
|
308 |
278 |
$5K |
| D0270 |
|
911 |
806 |
$5K |
| D2954 |
|
31 |
26 |
$4K |
| D7250 |
|
33 |
14 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
41 |
$3K |
| D2160 |
|
29 |
25 |
$2K |
| D2394 |
|
14 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$503.40 |
| D0431 |
|
32 |
28 |
$0.00 |
| D1999 |
|
24 |
21 |
$0.00 |