| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,681 |
3,763 |
$490K |
| D1110 |
Prophylaxis - adult |
7,262 |
6,833 |
$380K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,544 |
1,706 |
$303K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,467 |
7,918 |
$298K |
| D0330 |
Panoramic radiographic image |
7,788 |
7,285 |
$266K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,178 |
1,111 |
$224K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,441 |
1,582 |
$200K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,389 |
2,275 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,804 |
8,297 |
$160K |
| D0274 |
Bitewings - four radiographic images |
10,286 |
9,687 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,172 |
3,992 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
3,918 |
3,627 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
10,127 |
9,466 |
$85K |
| D4341 |
|
3,740 |
1,069 |
$84K |
| D2331 |
|
598 |
368 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,169 |
6,865 |
$36K |
| D2332 |
|
300 |
188 |
$22K |
| D1999 |
|
1,336 |
1,084 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
30 |
12 |
$7K |
| D2394 |
|
109 |
85 |
$7K |
| D2330 |
|
183 |
91 |
$6K |
| D9110 |
|
105 |
100 |
$4K |
| D2335 |
|
39 |
25 |
$3K |
| D1206 |
Topical application of fluoride varnish |
168 |
162 |
$2K |
| D4910 |
|
41 |
38 |
$1K |
| D4346 |
|
38 |
34 |
$1K |
| D0270 |
|
329 |
297 |
$1K |
| D9630 |
|
15 |
15 |
$675.00 |
| D3221 |
|
15 |
12 |
$579.60 |
| D1120 |
Prophylaxis - child |
16 |
16 |
$321.72 |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$293.58 |