| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,566 |
9,402 |
$1.15M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
10,499 |
5,428 |
$742K |
| D0330 |
Panoramic radiographic image |
14,298 |
13,511 |
$681K |
| D1110 |
Prophylaxis - adult |
15,064 |
14,292 |
$546K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,645 |
2,419 |
$481K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17,216 |
16,204 |
$476K |
| D0274 |
Bitewings - four radiographic images |
19,650 |
18,592 |
$418K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,513 |
3,170 |
$411K |
| D0120 |
Periodic oral evaluation - established patient |
21,879 |
20,798 |
$406K |
| D2394 |
|
2,145 |
1,301 |
$178K |
| D0140 |
Limited oral evaluation - problem focused |
6,193 |
5,662 |
$150K |
| D2740 |
Crown - porcelain/ceramic |
178 |
104 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,731 |
6,395 |
$111K |
| D2335 |
|
1,143 |
565 |
$107K |
| D2950 |
|
1,414 |
983 |
$104K |
| D1120 |
Prophylaxis - child |
4,936 |
4,700 |
$101K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
231 |
207 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
16,459 |
14,828 |
$92K |
| D7240 |
Removal of impacted tooth - completely bony |
254 |
128 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,194 |
5,319 |
$90K |
| D1351 |
Sealant - per tooth |
2,829 |
576 |
$64K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
877 |
479 |
$51K |
| D4342 |
|
624 |
161 |
$48K |
| D2332 |
|
581 |
348 |
$36K |
| D3320 |
|
133 |
110 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
446 |
207 |
$29K |
| D0180 |
|
874 |
834 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,661 |
1,620 |
$27K |
| D2330 |
|
514 |
251 |
$26K |
| D4341 |
|
256 |
65 |
$23K |
| D2160 |
|
319 |
177 |
$23K |
| D9944 |
|
83 |
81 |
$21K |
| D2331 |
|
355 |
217 |
$20K |
| D7230 |
|
72 |
41 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
404 |
340 |
$16K |
| D2931 |
|
126 |
95 |
$15K |
| D5214 |
|
28 |
27 |
$13K |
| D2140 |
|
268 |
118 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,109 |
1,057 |
$11K |
| D5213 |
|
15 |
15 |
$8K |
| D4910 |
|
101 |
94 |
$4K |
| D9946 |
|
14 |
13 |
$3K |
| D5110 |
|
13 |
12 |
$3K |
| D8030 |
|
37 |
36 |
$3K |
| D7310 |
|
22 |
12 |
$2K |
| D2161 |
|
23 |
14 |
$2K |
| D0350 |
|
113 |
68 |
$1K |
| D1320 |
|
19 |
19 |
$316.20 |