| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,657 |
2,543 |
$339K |
| D2740 |
Crown - porcelain/ceramic |
274 |
158 |
$221K |
| D0210 |
Intraoral - complete series of radiographic images |
3,881 |
3,444 |
$210K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,225 |
1,708 |
$180K |
| D1110 |
Prophylaxis - adult |
4,477 |
4,321 |
$167K |
| D0140 |
Limited oral evaluation - problem focused |
7,234 |
6,639 |
$167K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,161 |
1,205 |
$158K |
| D0330 |
Panoramic radiographic image |
3,221 |
3,127 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,219 |
5,039 |
$148K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,788 |
672 |
$103K |
| D4342 |
|
1,141 |
429 |
$103K |
| D2394 |
|
1,151 |
760 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,713 |
4,549 |
$100K |
| D9243 |
|
1,933 |
472 |
$98K |
| D2335 |
|
943 |
460 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,790 |
4,657 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,078 |
529 |
$64K |
| D7240 |
Removal of impacted tooth - completely bony |
333 |
127 |
$60K |
| D1120 |
Prophylaxis - child |
2,717 |
2,664 |
$58K |
| D9239 |
|
732 |
689 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,802 |
2,734 |
$48K |
| D4341 |
|
418 |
134 |
$39K |
| D9610 |
|
541 |
491 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,847 |
2,232 |
$35K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
518 |
123 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,427 |
4,026 |
$24K |
| D9222 |
|
175 |
164 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,593 |
1,570 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,181 |
1,154 |
$17K |
| D2950 |
|
123 |
79 |
$16K |
| D0250 |
|
1,130 |
1,065 |
$14K |
| D3320 |
|
29 |
26 |
$13K |
| D0180 |
|
395 |
380 |
$13K |
| D2331 |
|
164 |
105 |
$10K |
| D9612 |
|
168 |
165 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
151 |
79 |
$8K |
| D7230 |
|
61 |
24 |
$8K |
| D2330 |
|
133 |
54 |
$7K |
| D7241 |
|
33 |
14 |
$6K |
| D2140 |
|
140 |
61 |
$6K |
| D2954 |
|
16 |
12 |
$4K |
| D7310 |
|
30 |
12 |
$3K |
| D2332 |
|
33 |
24 |
$3K |
| D2160 |
|
24 |
14 |
$2K |
| D7250 |
|
19 |
12 |
$1K |
| D4910 |
|
17 |
13 |
$580.21 |