| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,231 |
1,422 |
$218K |
| D1110 |
Prophylaxis - adult |
2,894 |
2,876 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
832 |
581 |
$91K |
| D2740 |
Crown - porcelain/ceramic |
147 |
112 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,119 |
3,101 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,973 |
1,823 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
796 |
554 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,150 |
2,137 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,458 |
1,454 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,690 |
3,580 |
$47K |
| D0330 |
Panoramic radiographic image |
919 |
919 |
$45K |
| D2950 |
|
247 |
205 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,258 |
2,638 |
$35K |
| D1120 |
Prophylaxis - child |
720 |
715 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
793 |
691 |
$29K |
| D1206 |
Topical application of fluoride varnish |
982 |
979 |
$25K |
| D4341 |
|
151 |
65 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
106 |
$14K |
| D4910 |
|
39 |
39 |
$4K |
| D4355 |
|
29 |
29 |
$2K |
| D4346 |
|
12 |
12 |
$652.95 |
| D0180 |
|
27 |
27 |
$180.00 |