| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,714 |
962 |
$139K |
| D8670 |
Periodic orthodontic treatment visit |
446 |
436 |
$119K |
| D1110 |
Prophylaxis - adult |
2,092 |
1,983 |
$112K |
| D0274 |
Bitewings - four radiographic images |
1,852 |
1,758 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
938 |
525 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,184 |
2,077 |
$51K |
| D2740 |
Crown - porcelain/ceramic |
71 |
53 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
362 |
240 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
737 |
703 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
415 |
390 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
601 |
565 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,697 |
1,565 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
788 |
753 |
$23K |
| D1120 |
Prophylaxis - child |
419 |
404 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,371 |
853 |
$15K |
| D2950 |
|
92 |
70 |
$14K |
| D2332 |
|
83 |
51 |
$10K |
| D9310 |
|
130 |
125 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
27 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
12 |
$6K |
| D2335 |
|
23 |
12 |
$3K |
| D7311 |
|
16 |
12 |
$2K |
| D2330 |
|
30 |
14 |
$2K |
| D0270 |
|
131 |
123 |
$2K |
| D2394 |
|
14 |
12 |
$1K |
| D8660 |
|
14 |
14 |
$1K |
| D1354 |
|
67 |
24 |
$990.00 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$563.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$331.00 |
| D0350 |
|
15 |
15 |
$0.00 |