| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40,951 |
13,466 |
$3.63M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46,017 |
13,601 |
$3.31M |
| D2332 |
|
20,679 |
5,720 |
$2.29M |
| D2740 |
Crown - porcelain/ceramic |
3,146 |
1,986 |
$2.24M |
| D1110 |
Prophylaxis - adult |
21,436 |
20,967 |
$1.16M |
| D8670 |
Periodic orthodontic treatment visit |
3,869 |
3,595 |
$941K |
| D2335 |
|
5,245 |
2,561 |
$750K |
| D2330 |
|
8,799 |
3,770 |
$678K |
| D0120 |
Periodic oral evaluation - established patient |
26,571 |
26,126 |
$648K |
| D1120 |
Prophylaxis - child |
9,426 |
9,348 |
$483K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,950 |
2,529 |
$444K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,405 |
14,227 |
$421K |
| D0330 |
Panoramic radiographic image |
6,896 |
6,753 |
$414K |
| D0274 |
Bitewings - four radiographic images |
11,062 |
10,860 |
$400K |
| D0220 |
Intraoral - periapical first radiographic image |
15,760 |
14,392 |
$246K |
| D2950 |
|
1,490 |
894 |
$240K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
337 |
178 |
$189K |
| D2331 |
|
1,974 |
727 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,388 |
3,324 |
$157K |
| D2954 |
|
775 |
498 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,012 |
9,334 |
$130K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
154 |
145 |
$117K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,198 |
522 |
$112K |
| D9110 |
|
2,483 |
2,374 |
$104K |
| D2394 |
|
594 |
399 |
$72K |
| D4341 |
|
572 |
210 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,318 |
2,280 |
$64K |
| D9310 |
|
1,037 |
912 |
$54K |
| D1351 |
Sealant - per tooth |
897 |
347 |
$38K |
| D8660 |
|
972 |
922 |
$34K |
| D2140 |
|
441 |
212 |
$33K |
| D3320 |
|
41 |
30 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
180 |
136 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
234 |
144 |
$21K |
| D4342 |
|
222 |
77 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
296 |
$12K |
| D8680 |
|
106 |
91 |
$9K |
| D3310 |
|
17 |
12 |
$8K |
| D8690 |
|
64 |
58 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
90 |
$6K |