| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,342 |
4,304 |
$798K |
| D1110 |
Prophylaxis - adult |
14,539 |
13,844 |
$703K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,620 |
3,959 |
$676K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,719 |
2,921 |
$673K |
| D0120 |
Periodic oral evaluation - established patient |
19,748 |
18,756 |
$523K |
| D0140 |
Limited oral evaluation - problem focused |
11,459 |
10,711 |
$471K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,157 |
2,641 |
$361K |
| D0274 |
Bitewings - four radiographic images |
9,658 |
9,170 |
$301K |
| D1206 |
Topical application of fluoride varnish |
14,178 |
13,411 |
$293K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,007 |
5,584 |
$293K |
| D0210 |
Intraoral - complete series of radiographic images |
4,284 |
4,003 |
$279K |
| D1120 |
Prophylaxis - child |
6,573 |
6,275 |
$245K |
| D0330 |
Panoramic radiographic image |
3,452 |
3,243 |
$219K |
| D0220 |
Intraoral - periapical first radiographic image |
11,053 |
10,312 |
$183K |
| D7250 |
|
1,468 |
593 |
$170K |
| D1351 |
Sealant - per tooth |
6,726 |
1,093 |
$164K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
924 |
749 |
$154K |
| D4910 |
|
584 |
552 |
$41K |
| D4346 |
|
494 |
423 |
$32K |
| D2950 |
|
107 |
95 |
$16K |
| D2335 |
|
104 |
74 |
$16K |
| D2394 |
|
73 |
62 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,787 |
1,437 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
211 |
196 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$10K |
| D4355 |
|
95 |
92 |
$7K |
| D1354 |
|
404 |
112 |
$7K |
| D3310 |
|
13 |
12 |
$5K |
| D0270 |
|
302 |
288 |
$4K |
| D9110 |
|
44 |
41 |
$3K |
| D0272 |
Bitewings - two radiographic images |
75 |
68 |
$2K |
| D1330 |
|
154 |
150 |
$2K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
16 |
14 |
$0.00 |