| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,239 |
1,420 |
$208K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,732 |
1,136 |
$166K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,832 |
974 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
2,401 |
2,387 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,809 |
1,803 |
$112K |
| D2160 |
|
1,311 |
664 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,463 |
4,782 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,568 |
782 |
$81K |
| D1120 |
Prophylaxis - child |
1,909 |
1,890 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,064 |
3,058 |
$60K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
122 |
105 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,400 |
2,383 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
220 |
133 |
$25K |
| D2954 |
|
236 |
174 |
$25K |
| D9430 |
|
727 |
712 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
492 |
485 |
$21K |
| D2140 |
|
373 |
190 |
$19K |
| D4341 |
|
243 |
96 |
$17K |
| D4910 |
|
176 |
176 |
$13K |
| D0350 |
|
1,157 |
403 |
$11K |
| D2394 |
|
91 |
73 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D1110 |
Prophylaxis - adult |
80 |
79 |
$6K |
| D2332 |
|
45 |
25 |
$4K |
| D0270 |
|
370 |
365 |
$2K |
| D2330 |
|
17 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
27 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
41 |
40 |
$420.00 |