| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,445 |
2,239 |
$601K |
| D1110 |
Prophylaxis - adult |
5,017 |
4,954 |
$235K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,041 |
1,057 |
$216K |
| D0350 |
|
5,629 |
4,364 |
$215K |
| D2740 |
Crown - porcelain/ceramic |
385 |
285 |
$198K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,076 |
714 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
4,844 |
4,798 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,389 |
3,365 |
$102K |
| D0330 |
Panoramic radiographic image |
1,423 |
1,416 |
$75K |
| D1206 |
Topical application of fluoride varnish |
3,021 |
2,974 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,653 |
1,621 |
$57K |
| D1120 |
Prophylaxis - child |
1,546 |
1,541 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,006 |
1,005 |
$41K |
| D0460 |
|
1,500 |
1,435 |
$39K |
| D2950 |
|
303 |
241 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,013 |
2,931 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
368 |
147 |
$35K |
| D0180 |
|
500 |
496 |
$21K |
| D2394 |
|
89 |
69 |
$17K |
| D2332 |
|
110 |
65 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
898 |
$13K |
| D0240 |
|
284 |
282 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
309 |
290 |
$10K |
| D0272 |
Bitewings - two radiographic images |
215 |
214 |
$5K |
| D2335 |
|
16 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$173.58 |