| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,344 |
1,307 |
$146K |
| D1110 |
Prophylaxis - adult |
2,471 |
2,344 |
$71K |
| D2740 |
Crown - porcelain/ceramic |
286 |
210 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
570 |
389 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
997 |
614 |
$48K |
| D2950 |
|
391 |
308 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,596 |
1,399 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,379 |
2,292 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,726 |
1,636 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,851 |
2,406 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
532 |
414 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,049 |
932 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,053 |
1,046 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,561 |
1,646 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$11K |
| D4910 |
|
439 |
437 |
$10K |
| D1120 |
Prophylaxis - child |
354 |
350 |
$10K |
| D9610 |
|
875 |
832 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D2331 |
|
36 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$912.47 |
| D3120 |
|
53 |
36 |
$813.62 |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
43 |
$0.00 |
| D4341 |
|
128 |
39 |
$0.00 |
| D1999 |
|
15 |
14 |
$0.00 |