| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,392 |
2,078 |
$457K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,567 |
1,036 |
$432K |
| D2740 |
Crown - porcelain/ceramic |
638 |
509 |
$289K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,110 |
1,355 |
$221K |
| D1110 |
Prophylaxis - adult |
4,988 |
4,924 |
$209K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,643 |
4,575 |
$180K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
917 |
600 |
$150K |
| D0330 |
Panoramic radiographic image |
2,336 |
2,296 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
3,333 |
3,248 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,548 |
1,518 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,304 |
4,257 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,294 |
3,257 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
378 |
200 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,372 |
4,236 |
$54K |
| D4342 |
|
379 |
157 |
$35K |
| D2950 |
|
213 |
179 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
62 |
56 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
937 |
924 |
$21K |
| D5110 |
|
25 |
25 |
$20K |
| D2332 |
|
82 |
50 |
$12K |
| D4910 |
|
178 |
173 |
$12K |
| D5120 |
|
13 |
13 |
$11K |
| D1206 |
Topical application of fluoride varnish |
604 |
600 |
$10K |
| D2331 |
|
58 |
45 |
$7K |
| D2750 |
|
16 |
15 |
$7K |
| D0270 |
|
342 |
331 |
$4K |
| D2394 |
|
21 |
14 |
$4K |
| D4346 |
|
80 |
80 |
$4K |
| D2335 |
|
17 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
91 |
91 |
$3K |
| D2330 |
|
14 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$571.76 |