| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,309 |
1,465 |
$454K |
| D2740 |
Crown - porcelain/ceramic |
730 |
488 |
$387K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,948 |
857 |
$208K |
| D1110 |
Prophylaxis - adult |
4,464 |
4,451 |
$198K |
| D0274 |
Bitewings - four radiographic images |
5,084 |
5,065 |
$149K |
| D0330 |
Panoramic radiographic image |
2,624 |
2,617 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
782 |
516 |
$129K |
| D4341 |
|
788 |
217 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
5,187 |
5,164 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,002 |
2,988 |
$120K |
| D4910 |
|
1,188 |
1,184 |
$85K |
| D2950 |
|
601 |
419 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
492 |
326 |
$76K |
| D4342 |
|
798 |
221 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,721 |
1,699 |
$61K |
| D4346 |
|
920 |
913 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,204 |
3,129 |
$40K |
| D2330 |
|
205 |
85 |
$20K |
| D2332 |
|
114 |
64 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,038 |
1,031 |
$14K |
| D1206 |
Topical application of fluoride varnish |
699 |
698 |
$12K |
| D1120 |
Prophylaxis - child |
139 |
138 |
$5K |
| D2394 |
|
14 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
116 |
114 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$337.73 |