| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,951 |
2,853 |
$328K |
| D0120 |
Periodic oral evaluation - established patient |
3,579 |
3,562 |
$202K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,980 |
8,342 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,718 |
2,706 |
$168K |
| D1110 |
Prophylaxis - adult |
1,597 |
1,588 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,473 |
1,598 |
$133K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
271 |
213 |
$129K |
| D1120 |
Prophylaxis - child |
3,168 |
3,154 |
$119K |
| D4341 |
|
1,538 |
421 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
8,174 |
7,594 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,214 |
900 |
$96K |
| D9430 |
|
2,978 |
2,726 |
$95K |
| D4910 |
|
899 |
897 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,899 |
4,876 |
$59K |
| D0350 |
|
2,657 |
1,934 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
380 |
253 |
$43K |
| D2330 |
|
233 |
139 |
$18K |
| D0330 |
Panoramic radiographic image |
420 |
419 |
$12K |
| D0340 |
|
236 |
236 |
$12K |
| D0272 |
Bitewings - two radiographic images |
599 |
596 |
$7K |
| D1351 |
Sealant - per tooth |
162 |
46 |
$4K |
| D2331 |
|
53 |
25 |
$4K |
| D2954 |
|
16 |
14 |
$2K |
| D4342 |
|
35 |
12 |
$1K |
| D7111 |
|
18 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$367.20 |
| D1999 |
|
104 |
96 |
$40.00 |
| D3120 |
|
15 |
12 |
$0.00 |