| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,807 |
2,776 |
$365K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,460 |
4,453 |
$292K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,714 |
613 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,764 |
1,691 |
$183K |
| D1110 |
Prophylaxis - adult |
1,836 |
1,809 |
$155K |
| D2740 |
Crown - porcelain/ceramic |
317 |
215 |
$149K |
| D0210 |
Intraoral - complete series of radiographic images |
2,994 |
2,986 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
2,117 |
2,113 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,369 |
3,504 |
$75K |
| D1120 |
Prophylaxis - child |
1,434 |
1,419 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,128 |
2,124 |
$44K |
| D0350 |
|
2,403 |
1,021 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,389 |
1,372 |
$22K |
| D2330 |
|
148 |
87 |
$12K |
| D4341 |
|
97 |
39 |
$7K |
| D9430 |
|
198 |
193 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
735 |
732 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
52 |
$6K |
| D4910 |
|
25 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
80 |
80 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$336.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |
| D4346 |
|
61 |
61 |
$0.00 |
| D7953 |
|
22 |
13 |
$0.00 |
| D1999 |
|
26 |
26 |
$0.00 |