| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,024 |
3,587 |
$480K |
| D1110 |
Prophylaxis - adult |
7,403 |
7,353 |
$286K |
| D2740 |
Crown - porcelain/ceramic |
430 |
327 |
$276K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,718 |
2,297 |
$270K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,504 |
2,625 |
$260K |
| D0210 |
Intraoral - complete series of radiographic images |
4,600 |
4,534 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
9,522 |
9,472 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,080 |
6,057 |
$173K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,841 |
1,391 |
$170K |
| D0140 |
Limited oral evaluation - problem focused |
5,679 |
5,550 |
$155K |
| D4341 |
|
1,075 |
364 |
$148K |
| D0274 |
Bitewings - four radiographic images |
5,728 |
5,705 |
$140K |
| D1351 |
Sealant - per tooth |
4,242 |
540 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,454 |
1,009 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
10,325 |
10,049 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,172 |
6,938 |
$72K |
| D1120 |
Prophylaxis - child |
1,705 |
1,705 |
$70K |
| D4910 |
|
714 |
714 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,142 |
2,141 |
$50K |
| D2330 |
|
727 |
429 |
$33K |
| D2950 |
|
191 |
174 |
$32K |
| D4342 |
|
305 |
96 |
$25K |
| D2331 |
|
372 |
257 |
$23K |
| D2332 |
|
186 |
137 |
$15K |
| D0330 |
Panoramic radiographic image |
411 |
407 |
$14K |
| D5213 |
|
13 |
13 |
$8K |
| D0272 |
Bitewings - two radiographic images |
299 |
298 |
$7K |
| D2394 |
|
72 |
56 |
$6K |
| D2335 |
|
55 |
37 |
$4K |
| D4355 |
|
185 |
184 |
$4K |
| D0270 |
|
218 |
210 |
$2K |
| D0460 |
|
63 |
59 |
$0.00 |