| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,614 |
1,864 |
$218K |
| D0274 |
Bitewings - four radiographic images |
5,797 |
5,594 |
$177K |
| D1110 |
Prophylaxis - adult |
3,360 |
3,257 |
$164K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,258 |
1,124 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,055 |
4,887 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
3,816 |
3,692 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
9,087 |
8,433 |
$91K |
| D2740 |
Crown - porcelain/ceramic |
187 |
126 |
$88K |
| D0330 |
Panoramic radiographic image |
1,532 |
1,474 |
$72K |
| D1120 |
Prophylaxis - child |
1,507 |
1,463 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,864 |
1,783 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,641 |
6,348 |
$58K |
| D2394 |
|
741 |
445 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
675 |
238 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,960 |
1,915 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
614 |
413 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,512 |
1,447 |
$23K |
| D2950 |
|
144 |
99 |
$16K |
| D4341 |
|
151 |
52 |
$13K |
| D1351 |
Sealant - per tooth |
573 |
116 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
78 |
41 |
$7K |
| D2335 |
|
63 |
33 |
$5K |
| D4910 |
|
41 |
40 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
45 |
$2K |
| D2331 |
|
38 |
24 |
$2K |
| D0431 |
|
177 |
171 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$263.89 |