| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,026 |
1,126 |
$272K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
542 |
378 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,842 |
1,835 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,904 |
2,891 |
$71K |
| D1110 |
Prophylaxis - adult |
1,340 |
1,336 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,694 |
1,688 |
$50K |
| D4342 |
|
518 |
201 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
50 |
27 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,483 |
3,425 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
372 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
679 |
678 |
$15K |
| D4910 |
|
162 |
160 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
75 |
38 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
283 |
280 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
39 |
$6K |
| D2950 |
|
44 |
27 |
$6K |
| D1206 |
Topical application of fluoride varnish |
165 |
161 |
$5K |
| D0460 |
|
124 |
123 |
$3K |