| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,991 |
3,784 |
$422K |
| D1110 |
Prophylaxis - adult |
6,512 |
6,497 |
$300K |
| D1120 |
Prophylaxis - child |
5,492 |
5,492 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
7,738 |
7,730 |
$202K |
| D2740 |
Crown - porcelain/ceramic |
285 |
254 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,096 |
5,096 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,204 |
4,197 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
2,223 |
2,165 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
936 |
797 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,335 |
1,068 |
$74K |
| D0274 |
Bitewings - four radiographic images |
5,325 |
5,313 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,534 |
2,531 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,528 |
2,524 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
465 |
364 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
40 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,534 |
3,510 |
$18K |
| D2954 |
|
155 |
142 |
$15K |
| D2332 |
|
116 |
86 |
$8K |
| D1206 |
Topical application of fluoride varnish |
190 |
190 |
$6K |
| D1351 |
Sealant - per tooth |
256 |
47 |
$5K |
| D3221 |
|
98 |
88 |
$4K |
| D2331 |
|
55 |
39 |
$4K |
| D0270 |
|
596 |
591 |
$3K |
| D2335 |
|
17 |
13 |
$2K |
| D0603 |
|
100 |
100 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
47 |
$200.75 |
| D0602 |
|
13 |
13 |
$130.00 |