| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,750 |
2,809 |
$640K |
| D1110 |
Prophylaxis - adult |
6,465 |
6,412 |
$314K |
| D0210 |
Intraoral - complete series of radiographic images |
3,761 |
3,733 |
$306K |
| D2740 |
Crown - porcelain/ceramic |
507 |
368 |
$286K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,565 |
5,490 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
6,989 |
6,943 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,613 |
761 |
$160K |
| D4341 |
|
755 |
306 |
$153K |
| D0274 |
Bitewings - four radiographic images |
4,762 |
4,734 |
$145K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,045 |
661 |
$110K |
| D0140 |
Limited oral evaluation - problem focused |
2,632 |
2,613 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
6,517 |
6,441 |
$82K |
| D4342 |
|
628 |
267 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
357 |
260 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,219 |
2,210 |
$37K |
| D2950 |
|
105 |
87 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
53 |
$12K |
| D0383 |
|
53 |
53 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
217 |
216 |
$3K |
| D1206 |
Topical application of fluoride varnish |
65 |
65 |
$2K |
| D0270 |
|
139 |
139 |
$2K |
| D4910 |
|
16 |
15 |
$1K |
| D0351 |
|
12 |
12 |
$380.07 |