| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,556 |
5,670 |
$1.50M |
| D2740 |
Crown - porcelain/ceramic |
1,709 |
1,075 |
$967K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,089 |
4,005 |
$918K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,184 |
2,138 |
$504K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,994 |
1,653 |
$471K |
| D4342 |
|
4,675 |
1,983 |
$434K |
| D0210 |
Intraoral - complete series of radiographic images |
4,162 |
4,031 |
$313K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,858 |
6,604 |
$267K |
| D2950 |
|
2,043 |
1,564 |
$252K |
| D0140 |
Limited oral evaluation - problem focused |
5,859 |
5,652 |
$200K |
| D1110 |
Prophylaxis - adult |
3,685 |
3,521 |
$156K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
229 |
214 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
5,399 |
5,171 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
8,381 |
8,027 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,248 |
3,062 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,259 |
3,114 |
$91K |
| D2332 |
|
585 |
359 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
678 |
248 |
$65K |
| D0460 |
|
2,124 |
2,082 |
$56K |
| D2330 |
|
418 |
250 |
$42K |
| D2331 |
|
185 |
116 |
$22K |
| D1120 |
Prophylaxis - child |
390 |
376 |
$12K |
| D3320 |
|
31 |
27 |
$11K |
| D2335 |
|
51 |
37 |
$9K |
| D1206 |
Topical application of fluoride varnish |
472 |
456 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
264 |
248 |
$3K |
| D4910 |
|
37 |
36 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$778.06 |
| D0270 |
|
39 |
39 |
$494.91 |