| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,948 |
1,877 |
$496K |
| D2332 |
|
879 |
398 |
$94K |
| D4341 |
|
728 |
187 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,303 |
644 |
$71K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
610 |
282 |
$66K |
| D4346 |
|
536 |
536 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,743 |
1,736 |
$59K |
| D2331 |
|
679 |
312 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,645 |
2,635 |
$46K |
| D1110 |
Prophylaxis - adult |
1,029 |
1,023 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,954 |
1,946 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,063 |
3,026 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,852 |
2,762 |
$27K |
| D1120 |
Prophylaxis - child |
800 |
796 |
$24K |
| D0330 |
Panoramic radiographic image |
917 |
909 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
843 |
836 |
$19K |
| D0274 |
Bitewings - four radiographic images |
566 |
562 |
$17K |
| D5213 |
|
13 |
13 |
$11K |
| D5214 |
|
12 |
12 |
$9K |
| D1351 |
Sealant - per tooth |
446 |
121 |
$9K |
| D2335 |
|
89 |
27 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
47 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
205 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
43 |
$2K |
| D2394 |
|
14 |
13 |
$1K |
| D0602 |
|
633 |
546 |
$0.00 |
| D0603 |
|
264 |
202 |
$0.00 |
| D0601 |
|
289 |
286 |
$0.00 |