| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,772 |
1,208 |
$236K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,017 |
762 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,068 |
699 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,635 |
$72K |
| D2740 |
Crown - porcelain/ceramic |
111 |
96 |
$70K |
| D2394 |
|
240 |
196 |
$48K |
| D0350 |
|
258 |
250 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,289 |
1,281 |
$35K |
| D2335 |
|
119 |
72 |
$24K |
| D2950 |
|
146 |
116 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
169 |
$14K |
| D2332 |
|
71 |
52 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
43 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
226 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
560 |
543 |
$7K |
| D0180 |
|
75 |
75 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
127 |
$3K |
| D0274 |
Bitewings - four radiographic images |
68 |
66 |
$2K |