| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,565 |
2,009 |
$372K |
| D1110 |
Prophylaxis - adult |
6,259 |
6,240 |
$256K |
| D0120 |
Periodic oral evaluation - established patient |
7,534 |
7,492 |
$174K |
| D0210 |
Intraoral - complete series of radiographic images |
2,531 |
2,497 |
$131K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,103 |
720 |
$123K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,409 |
811 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,399 |
3,391 |
$92K |
| D1120 |
Prophylaxis - child |
2,054 |
2,050 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,314 |
2,306 |
$77K |
| D2740 |
Crown - porcelain/ceramic |
108 |
72 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,637 |
2,631 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
2,341 |
2,276 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
5,011 |
4,857 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
445 |
199 |
$52K |
| D4341 |
|
278 |
98 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,683 |
3,392 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
353 |
170 |
$19K |
| D1351 |
Sealant - per tooth |
604 |
159 |
$18K |
| D0330 |
Panoramic radiographic image |
308 |
306 |
$11K |
| D4910 |
|
73 |
73 |
$7K |
| D4355 |
|
161 |
161 |
$6K |
| D0272 |
Bitewings - two radiographic images |
118 |
118 |
$3K |