| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,696 |
1,461 |
$180K |
| D2740 |
Crown - porcelain/ceramic |
190 |
149 |
$148K |
| D0330 |
Panoramic radiographic image |
2,112 |
1,951 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,426 |
922 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,918 |
2,761 |
$101K |
| D1110 |
Prophylaxis - adult |
1,162 |
1,118 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,071 |
502 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,199 |
2,076 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
829 |
814 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,267 |
2,154 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,517 |
1,762 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
313 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
800 |
744 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,228 |
3,012 |
$22K |
| D2394 |
|
206 |
151 |
$19K |
| D2950 |
|
120 |
92 |
$17K |
| D1206 |
Topical application of fluoride varnish |
522 |
505 |
$14K |
| D2335 |
|
61 |
45 |
$9K |
| D1120 |
Prophylaxis - child |
253 |
248 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
31 |
$4K |
| D2332 |
|
19 |
14 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
22 |
22 |
$315.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$235.80 |