| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,272 |
6,950 |
$893K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,146 |
4,272 |
$570K |
| D1110 |
Prophylaxis - adult |
10,331 |
9,873 |
$503K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,472 |
10,645 |
$406K |
| D0210 |
Intraoral - complete series of radiographic images |
8,712 |
8,085 |
$344K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,779 |
2,087 |
$300K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,474 |
1,926 |
$298K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,205 |
3,389 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,925 |
9,467 |
$186K |
| D2332 |
|
1,766 |
1,095 |
$159K |
| D2331 |
|
2,130 |
1,378 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
4,933 |
4,749 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
5,450 |
5,128 |
$147K |
| D0220 |
Intraoral - periapical first radiographic image |
12,247 |
11,573 |
$113K |
| D0274 |
Bitewings - four radiographic images |
7,095 |
6,794 |
$88K |
| D2335 |
|
477 |
286 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,379 |
8,005 |
$38K |
| D1999 |
|
4,036 |
3,369 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,346 |
1,279 |
$25K |
| D2330 |
|
457 |
328 |
$24K |
| D4341 |
|
974 |
472 |
$22K |
| D1120 |
Prophylaxis - child |
1,107 |
1,040 |
$22K |
| D3310 |
|
17 |
13 |
$8K |
| D2394 |
|
48 |
40 |
$6K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$344.08 |