| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,819 |
2,446 |
$777K |
| D2740 |
Crown - porcelain/ceramic |
666 |
328 |
$425K |
| D4342 |
|
2,992 |
1,077 |
$289K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,669 |
964 |
$272K |
| D0350 |
|
3,031 |
1,488 |
$210K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,742 |
970 |
$183K |
| D1110 |
Prophylaxis - adult |
3,073 |
2,963 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
4,733 |
4,537 |
$119K |
| D4910 |
|
1,461 |
1,368 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,323 |
3,228 |
$99K |
| D2950 |
|
711 |
357 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,143 |
2,110 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
5,974 |
5,770 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,835 |
4,680 |
$69K |
| D1206 |
Topical application of fluoride varnish |
2,627 |
2,495 |
$56K |
| D1120 |
Prophylaxis - child |
918 |
861 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
863 |
835 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
500 |
491 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
425 |
386 |
$14K |
| D2750 |
|
29 |
25 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
28 |
$7K |
| D2394 |
|
34 |
14 |
$6K |
| D0272 |
Bitewings - two radiographic images |
239 |
228 |
$5K |
| D2330 |
|
43 |
26 |
$4K |
| D9310 |
|
25 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$796.48 |