| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,770 |
880 |
$183K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,885 |
546 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,742 |
625 |
$90K |
| D2335 |
|
852 |
260 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
804 |
315 |
$50K |
| D1110 |
Prophylaxis - adult |
1,207 |
1,200 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,286 |
1,282 |
$31K |
| D0330 |
Panoramic radiographic image |
647 |
646 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,390 |
1,387 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
939 |
929 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
349 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
942 |
$14K |
| D1120 |
Prophylaxis - child |
526 |
524 |
$10K |
| D0274 |
Bitewings - four radiographic images |
533 |
533 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
22 |
12 |
$9K |
| D2330 |
|
143 |
51 |
$6K |
| D2931 |
|
44 |
32 |
$5K |
| D7220 |
|
28 |
16 |
$3K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$110.00 |