| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,346 |
1,066 |
$237K |
| D2740 |
Crown - porcelain/ceramic |
488 |
264 |
$237K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,178 |
671 |
$89K |
| D1110 |
Prophylaxis - adult |
1,718 |
1,677 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,834 |
1,775 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,357 |
1,228 |
$67K |
| D2950 |
|
504 |
302 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,577 |
1,539 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
421 |
197 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
401 |
157 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,669 |
1,624 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,930 |
2,691 |
$42K |
| D1120 |
Prophylaxis - child |
940 |
901 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,169 |
1,123 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,621 |
1,981 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
848 |
820 |
$18K |
| D4355 |
|
160 |
158 |
$13K |
| D4341 |
|
113 |
40 |
$12K |
| D2394 |
|
38 |
26 |
$6K |
| D4910 |
|
39 |
39 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
86 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$208.00 |
| D0603 |
|
33 |
30 |
$0.00 |