| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,729 |
737 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
828 |
411 |
$85K |
| D2740 |
Crown - porcelain/ceramic |
201 |
132 |
$68K |
| D1110 |
Prophylaxis - adult |
1,949 |
1,916 |
$57K |
| D2950 |
|
373 |
270 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
333 |
182 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,270 |
1,243 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,022 |
1,004 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,792 |
1,754 |
$21K |
| D1120 |
Prophylaxis - child |
683 |
663 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,874 |
1,808 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
992 |
967 |
$13K |
| D5211 |
|
13 |
13 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,459 |
1,288 |
$11K |
| D3320 |
|
15 |
13 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
424 |
410 |
$8K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
48 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
372 |
159 |
$4K |
| D2331 |
|
31 |
25 |
$4K |
| D2332 |
|
21 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
128 |
121 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
26 |
$1K |