| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,582 |
2,786 |
$733K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,068 |
2,388 |
$480K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,141 |
1,384 |
$346K |
| D0210 |
Intraoral - complete series of radiographic images |
4,305 |
4,096 |
$310K |
| D1110 |
Prophylaxis - adult |
5,168 |
4,874 |
$217K |
| D2740 |
Crown - porcelain/ceramic |
405 |
259 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,185 |
4,940 |
$196K |
| D0140 |
Limited oral evaluation - problem focused |
5,056 |
4,662 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,479 |
824 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
6,423 |
6,088 |
$143K |
| D4342 |
|
1,068 |
443 |
$97K |
| D4341 |
|
739 |
307 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,555 |
2,405 |
$71K |
| D2332 |
|
450 |
280 |
$66K |
| D2950 |
|
559 |
400 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,754 |
4,388 |
$56K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
114 |
99 |
$50K |
| D2335 |
|
191 |
128 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,215 |
1,117 |
$25K |
| D2394 |
|
122 |
99 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
105 |
72 |
$17K |
| D2331 |
|
70 |
51 |
$8K |
| D0272 |
Bitewings - two radiographic images |
372 |
366 |
$8K |
| D2330 |
|
62 |
25 |
$6K |
| D0330 |
Panoramic radiographic image |
76 |
76 |
$4K |
| D0270 |
|
120 |
109 |
$1K |