| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,668 |
1,331 |
$175K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
321 |
222 |
$152K |
| D1110 |
Prophylaxis - adult |
1,428 |
1,422 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,803 |
1,797 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
1,761 |
1,754 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,491 |
839 |
$80K |
| D1120 |
Prophylaxis - child |
1,612 |
1,611 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,357 |
1,353 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
806 |
487 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
448 |
286 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,463 |
2,221 |
$51K |
| D4341 |
|
654 |
247 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,024 |
3,017 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,484 |
1,477 |
$31K |
| D4910 |
|
359 |
359 |
$27K |
| D2331 |
|
191 |
114 |
$15K |
| D9430 |
|
355 |
354 |
$11K |
| D2954 |
|
90 |
74 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
267 |
267 |
$3K |
| D2330 |
|
32 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
83 |
82 |
$2K |
| D4342 |
|
48 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D2140 |
|
22 |
13 |
$1K |
| D0350 |
|
95 |
28 |
$902.40 |