| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,605 |
2,065 |
$564K |
| D2740 |
Crown - porcelain/ceramic |
527 |
284 |
$325K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,430 |
992 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
6,438 |
6,433 |
$176K |
| D1120 |
Prophylaxis - child |
4,241 |
4,238 |
$170K |
| D1110 |
Prophylaxis - adult |
3,129 |
3,125 |
$163K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,162 |
4,159 |
$99K |
| D0274 |
Bitewings - four radiographic images |
2,913 |
2,907 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
423 |
304 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,388 |
1,353 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,090 |
3,004 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,741 |
1,580 |
$43K |
| D0330 |
Panoramic radiographic image |
645 |
644 |
$40K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
73 |
66 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
858 |
856 |
$36K |
| D2950 |
|
229 |
157 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,174 |
1,173 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
214 |
113 |
$27K |
| D2954 |
|
148 |
100 |
$26K |
| D4341 |
|
161 |
49 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
209 |
148 |
$18K |
| D0272 |
Bitewings - two radiographic images |
166 |
165 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
215 |
66 |
$3K |
| D7111 |
|
20 |
12 |
$1K |