| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,039 |
7,036 |
$788K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,287 |
4,545 |
$597K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,479 |
1,282 |
$517K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,565 |
4,453 |
$446K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,888 |
3,838 |
$399K |
| D4342 |
|
4,688 |
1,312 |
$385K |
| D0274 |
Bitewings - four radiographic images |
17,388 |
16,740 |
$368K |
| D1110 |
Prophylaxis - adult |
9,544 |
9,185 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
16,216 |
15,634 |
$295K |
| D2394 |
|
3,157 |
2,254 |
$248K |
| D2335 |
|
2,605 |
1,362 |
$241K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,881 |
8,468 |
$235K |
| D2740 |
Crown - porcelain/ceramic |
288 |
204 |
$228K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,068 |
16,872 |
$196K |
| D3320 |
|
650 |
543 |
$180K |
| D2332 |
|
2,405 |
1,397 |
$177K |
| D4341 |
|
1,472 |
487 |
$154K |
| D0210 |
Intraoral - complete series of radiographic images |
2,266 |
2,168 |
$126K |
| D0220 |
Intraoral - periapical first radiographic image |
19,912 |
18,766 |
$108K |
| D0330 |
Panoramic radiographic image |
2,492 |
2,295 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,347 |
6,091 |
$100K |
| D1120 |
Prophylaxis - child |
4,001 |
3,846 |
$80K |
| D2330 |
|
1,393 |
753 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,802 |
2,624 |
$65K |
| D3310 |
|
215 |
160 |
$50K |
| D4910 |
|
980 |
955 |
$46K |
| D2331 |
|
737 |
511 |
$43K |
| D2950 |
|
276 |
232 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,389 |
2,263 |
$23K |
| D1351 |
Sealant - per tooth |
828 |
195 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
312 |
172 |
$17K |
| D2140 |
|
167 |
94 |
$7K |
| D2160 |
|
91 |
63 |
$6K |
| D2161 |
|
77 |
60 |
$6K |
| D1320 |
|
43 |
42 |
$615.00 |
| D1999 |
|
18 |
16 |
$0.00 |