| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,770 |
2,688 |
$542K |
| D2740 |
Crown - porcelain/ceramic |
810 |
571 |
$469K |
| D1110 |
Prophylaxis - adult |
5,236 |
5,216 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,522 |
1,637 |
$218K |
| D1120 |
Prophylaxis - child |
5,338 |
5,332 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
7,713 |
7,705 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,469 |
1,002 |
$194K |
| D1206 |
Topical application of fluoride varnish |
6,469 |
6,461 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
2,473 |
2,385 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,499 |
3,477 |
$135K |
| D0274 |
Bitewings - four radiographic images |
3,259 |
3,253 |
$100K |
| D2950 |
|
638 |
491 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
5,169 |
5,104 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
2,016 |
1,987 |
$77K |
| D1351 |
Sealant - per tooth |
2,288 |
574 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
170 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,183 |
3,459 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
199 |
$29K |
| D0330 |
Panoramic radiographic image |
502 |
502 |
$27K |
| D4910 |
|
296 |
296 |
$22K |
| D0272 |
Bitewings - two radiographic images |
915 |
913 |
$20K |
| D4341 |
|
98 |
39 |
$11K |
| D2331 |
|
38 |
27 |
$4K |
| D4342 |
|
29 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$1K |
| D4355 |
|
12 |
12 |
$1K |
| D1999 |
|
83 |
80 |
$0.00 |