| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,017 |
1,000 |
$274K |
| D2740 |
Crown - porcelain/ceramic |
490 |
333 |
$265K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,521 |
395 |
$143K |
| D1110 |
Prophylaxis - adult |
2,474 |
2,468 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
951 |
489 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,309 |
3,299 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,261 |
2,259 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
395 |
252 |
$66K |
| D0330 |
Panoramic radiographic image |
998 |
995 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,261 |
1,258 |
$50K |
| D2950 |
|
354 |
235 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,848 |
2,808 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
891 |
878 |
$31K |
| D1120 |
Prophylaxis - child |
642 |
642 |
$22K |
| D2330 |
|
217 |
89 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,204 |
1,202 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
532 |
532 |
$7K |
| D2332 |
|
43 |
26 |
$6K |
| D1206 |
Topical application of fluoride varnish |
329 |
329 |
$6K |
| D4910 |
|
38 |
38 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
380 |
378 |
$3K |
| D2394 |
|
13 |
12 |
$2K |