| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,064 |
2,868 |
$225K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,634 |
1,832 |
$193K |
| D1110 |
Prophylaxis - adult |
4,685 |
4,525 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
2,785 |
2,692 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,509 |
1,774 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,601 |
1,312 |
$106K |
| D1206 |
Topical application of fluoride varnish |
6,979 |
6,677 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
3,923 |
3,700 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,520 |
3,393 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,137 |
3,952 |
$60K |
| D0330 |
Panoramic radiographic image |
1,497 |
1,409 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,011 |
2,887 |
$54K |
| D1351 |
Sealant - per tooth |
2,444 |
491 |
$40K |
| D1120 |
Prophylaxis - child |
1,741 |
1,683 |
$39K |
| D2331 |
|
636 |
478 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
360 |
249 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,872 |
3,523 |
$30K |
| D2394 |
|
305 |
277 |
$23K |
| D4346 |
|
473 |
439 |
$22K |
| D2335 |
|
276 |
196 |
$19K |
| D2332 |
|
265 |
202 |
$16K |
| D2330 |
|
335 |
259 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,512 |
1,093 |
$12K |
| D4355 |
|
155 |
151 |
$11K |
| D7250 |
|
54 |
25 |
$4K |
| D9110 |
|
179 |
171 |
$4K |
| D4341 |
|
43 |
26 |
$3K |
| D4342 |
|
73 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
174 |
172 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
79 |
$2K |
| D4910 |
|
54 |
49 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
113 |
$1K |