| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,319 |
1,144 |
$159K |
| D2740 |
Crown - porcelain/ceramic |
551 |
383 |
$153K |
| D1110 |
Prophylaxis - adult |
2,144 |
2,101 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
609 |
374 |
$60K |
| D2950 |
|
659 |
513 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
978 |
871 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
587 |
359 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,638 |
2,583 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,500 |
1,400 |
$37K |
| D9610 |
|
2,549 |
2,386 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,318 |
1,281 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,334 |
1,315 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,616 |
2,391 |
$20K |
| D1120 |
Prophylaxis - child |
646 |
636 |
$18K |
| D4910 |
|
509 |
505 |
$17K |
| D3320 |
|
31 |
24 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,710 |
1,401 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
711 |
685 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
32 |
26 |
$11K |
| D1351 |
Sealant - per tooth |
114 |
28 |
$5K |
| D4355 |
|
57 |
57 |
$4K |
| D9920 |
|
62 |
62 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$3K |
| D2394 |
|
15 |
12 |
$2K |
| D2331 |
|
14 |
13 |
$1K |
| D4341 |
|
188 |
74 |
$0.00 |