| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,406 |
1,968 |
$354K |
| D2335 |
|
3,403 |
1,314 |
$313K |
| D2394 |
|
2,760 |
1,570 |
$247K |
| D2740 |
Crown - porcelain/ceramic |
307 |
134 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,588 |
1,894 |
$225K |
| D0330 |
Panoramic radiographic image |
3,303 |
3,122 |
$168K |
| D1110 |
Prophylaxis - adult |
4,598 |
4,381 |
$164K |
| D0274 |
Bitewings - four radiographic images |
6,732 |
6,373 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
4,828 |
4,397 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
6,333 |
6,048 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,508 |
3,311 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,592 |
851 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,280 |
4,115 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
8,237 |
7,540 |
$49K |
| D2950 |
|
616 |
415 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,193 |
2,120 |
$35K |
| D2931 |
|
280 |
216 |
$34K |
| D1120 |
Prophylaxis - child |
1,617 |
1,560 |
$33K |
| D2332 |
|
508 |
269 |
$27K |
| D1351 |
Sealant - per tooth |
878 |
196 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
333 |
113 |
$20K |
| D0180 |
|
567 |
534 |
$19K |
| D2160 |
|
147 |
74 |
$10K |
| D2331 |
|
205 |
115 |
$9K |
| D0272 |
Bitewings - two radiographic images |
692 |
667 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$6K |
| D9944 |
|
26 |
25 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
64 |
$5K |
| D2161 |
|
55 |
42 |
$5K |
| D3320 |
|
16 |
13 |
$5K |
| D4341 |
|
35 |
12 |
$4K |
| D1206 |
Topical application of fluoride varnish |
197 |
191 |
$3K |
| D2140 |
|
65 |
44 |
$3K |
| D2330 |
|
76 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
62 |
$656.02 |