| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,058 |
1,008 |
$322K |
| D1351 |
Sealant - per tooth |
9,123 |
1,922 |
$301K |
| D1120 |
Prophylaxis - child |
6,740 |
6,632 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,131 |
1,070 |
$261K |
| D1206 |
Topical application of fluoride varnish |
9,778 |
9,617 |
$242K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,697 |
3,621 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
6,414 |
6,322 |
$189K |
| D2750 |
|
389 |
169 |
$162K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
208 |
153 |
$150K |
| D1110 |
Prophylaxis - adult |
2,323 |
2,289 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
10,018 |
9,488 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
2,085 |
1,926 |
$93K |
| D0330 |
Panoramic radiographic image |
1,798 |
1,756 |
$80K |
| D3320 |
|
129 |
79 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,302 |
3,240 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
702 |
416 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,783 |
3,716 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,025 |
7,810 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
499 |
305 |
$47K |
| D3120 |
|
1,294 |
476 |
$45K |
| D4355 |
|
374 |
362 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
93 |
50 |
$37K |
| D1330 |
|
5,286 |
5,190 |
$32K |
| D2950 |
|
253 |
126 |
$21K |
| D4341 |
|
226 |
63 |
$20K |
| D9944 |
|
90 |
87 |
$13K |
| D0460 |
|
68 |
68 |
$680.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$560.00 |