| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,897 |
1,435 |
$96K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
212 |
148 |
$86K |
| D1110 |
Prophylaxis - adult |
4,287 |
4,248 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,615 |
2,579 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,486 |
2,468 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,165 |
1,162 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,297 |
677 |
$35K |
| D4341 |
|
510 |
198 |
$26K |
| D0274 |
Bitewings - four radiographic images |
3,578 |
3,500 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
544 |
336 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
368 |
178 |
$17K |
| D1120 |
Prophylaxis - child |
785 |
777 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
823 |
802 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
5,263 |
5,132 |
$13K |
| D2950 |
|
221 |
152 |
$11K |
| D3320 |
|
39 |
27 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
459 |
254 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,863 |
4,086 |
$8K |
| D0180 |
|
321 |
319 |
$6K |
| D0330 |
Panoramic radiographic image |
1,586 |
1,559 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
763 |
756 |
$5K |
| D1351 |
Sealant - per tooth |
395 |
63 |
$2K |
| D2335 |
|
55 |
28 |
$2K |
| D2332 |
|
36 |
25 |
$1K |
| D7230 |
|
16 |
14 |
$810.00 |
| D2331 |
|
15 |
12 |
$576.00 |
| D9920 |
|
14 |
13 |
$103.00 |
| D0603 |
|
14 |
14 |
$70.00 |
| D9310 |
|
12 |
12 |
$0.00 |
| D1999 |
|
73 |
65 |
$0.00 |