| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27,214 |
7,661 |
$2.30M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,433 |
7,493 |
$1.93M |
| D4210 |
|
6,282 |
2,753 |
$1.92M |
| D1110 |
Prophylaxis - adult |
22,075 |
21,505 |
$1.33M |
| D0274 |
Bitewings - four radiographic images |
25,598 |
25,058 |
$1.03M |
| D1208 |
Topical application of fluoride, excluding varnish |
20,424 |
20,224 |
$598K |
| D0120 |
Periodic oral evaluation - established patient |
21,940 |
21,567 |
$581K |
| D0220 |
Intraoral - periapical first radiographic image |
28,264 |
27,507 |
$499K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,825 |
9,529 |
$492K |
| D1120 |
Prophylaxis - child |
8,418 |
8,338 |
$425K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,760 |
26,491 |
$399K |
| D0210 |
Intraoral - complete series of radiographic images |
3,351 |
3,262 |
$260K |
| D0140 |
Limited oral evaluation - problem focused |
4,404 |
4,248 |
$186K |
| D2740 |
Crown - porcelain/ceramic |
150 |
118 |
$110K |
| D7961 |
|
207 |
177 |
$57K |
| D7960 |
|
175 |
152 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
377 |
148 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
25 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
25 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
54 |
$13K |
| D2330 |
|
151 |
67 |
$13K |
| D1351 |
Sealant - per tooth |
283 |
65 |
$12K |
| D2954 |
|
15 |
12 |
$3K |
| D2394 |
|
20 |
13 |
$2K |
| D9941 |
|
12 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$390.00 |