| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,071 |
2,867 |
$813K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,697 |
2,112 |
$594K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,801 |
1,816 |
$458K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,349 |
820 |
$218K |
| D2740 |
Crown - porcelain/ceramic |
251 |
97 |
$212K |
| D1110 |
Prophylaxis - adult |
4,366 |
4,338 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,564 |
3,547 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
5,656 |
5,614 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
7,579 |
7,437 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,063 |
3,047 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,040 |
1,033 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,381 |
4,342 |
$80K |
| D2332 |
|
297 |
164 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,237 |
1,222 |
$42K |
| D2950 |
|
250 |
97 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,712 |
1,701 |
$29K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
36 |
26 |
$23K |
| D2335 |
|
132 |
73 |
$23K |
| D1120 |
Prophylaxis - child |
477 |
475 |
$14K |
| D1351 |
Sealant - per tooth |
394 |
103 |
$13K |
| D2330 |
|
126 |
63 |
$12K |
| D2394 |
|
54 |
41 |
$10K |
| D4342 |
|
94 |
39 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
137 |
137 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$456.24 |