| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,462 |
1,004 |
$68K |
| D1110 |
Prophylaxis - adult |
2,486 |
2,457 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
368 |
246 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,518 |
2,486 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
1,939 |
1,772 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,508 |
922 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,504 |
2,473 |
$35K |
| D2950 |
|
282 |
242 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,088 |
1,057 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,127 |
1,935 |
$14K |
| D4341 |
|
908 |
248 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
79 |
66 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
54 |
$10K |
| D0330 |
Panoramic radiographic image |
174 |
172 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
1,226 |
1,216 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
75 |
$4K |
| D1120 |
Prophylaxis - child |
101 |
101 |
$1K |
| D1206 |
Topical application of fluoride varnish |
81 |
81 |
$810.90 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$366.80 |
| D0270 |
|
12 |
12 |
$159.83 |
| D3320 |
|
18 |
15 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
54 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
118 |
118 |
$0.00 |
| D2330 |
|
77 |
40 |
$0.00 |