| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,187 |
1,264 |
$292K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,662 |
1,272 |
$257K |
| D2740 |
Crown - porcelain/ceramic |
358 |
214 |
$221K |
| D1110 |
Prophylaxis - adult |
3,346 |
3,336 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
4,262 |
4,205 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
4,869 |
4,852 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,201 |
2,194 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,490 |
2,489 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
672 |
422 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,369 |
5,295 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
144 |
118 |
$62K |
| D4342 |
|
664 |
300 |
$60K |
| D2950 |
|
220 |
184 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
371 |
368 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
869 |
861 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,019 |
1,010 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
75 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
144 |
66 |
$15K |
| D1120 |
Prophylaxis - child |
309 |
309 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
26 |
$6K |