| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2710 |
|
264 |
152 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,195 |
800 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
463 |
377 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
707 |
452 |
$61K |
| D1120 |
Prophylaxis - child |
1,467 |
1,467 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,115 |
2,115 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
433 |
$55K |
| D1110 |
Prophylaxis - adult |
820 |
820 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,771 |
$43K |
| D0274 |
Bitewings - four radiographic images |
739 |
738 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
161 |
125 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,300 |
$23K |
| D2394 |
|
49 |
38 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
203 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
138 |
$6K |
| D0272 |
Bitewings - two radiographic images |
215 |
215 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
541 |
451 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
37 |
30 |
$4K |
| D2950 |
|
20 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$1K |