| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,127 |
1,894 |
$238K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,272 |
1,823 |
$190K |
| D1110 |
Prophylaxis - adult |
4,466 |
4,459 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,233 |
1,017 |
$116K |
| D0274 |
Bitewings - four radiographic images |
4,665 |
4,650 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,347 |
3,341 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,500 |
4,489 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
7,323 |
7,176 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
729 |
533 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,070 |
2,036 |
$57K |
| D1120 |
Prophylaxis - child |
1,346 |
1,346 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,690 |
5,940 |
$48K |
| D2740 |
Crown - porcelain/ceramic |
73 |
59 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,847 |
1,847 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
495 |
303 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
312 |
309 |
$15K |
| D2950 |
|
73 |
60 |
$12K |
| D4341 |
|
64 |
27 |
$9K |
| D2940 |
|
111 |
90 |
$7K |
| D1351 |
Sealant - per tooth |
241 |
25 |
$7K |
| D0330 |
Panoramic radiographic image |
173 |
173 |
$4K |
| D0272 |
Bitewings - two radiographic images |
163 |
163 |
$4K |
| D1999 |
|
2,172 |
1,872 |
$0.00 |