| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,066 |
7,015 |
$924K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,384 |
4,878 |
$778K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,449 |
3,906 |
$724K |
| D2332 |
|
7,053 |
1,894 |
$553K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,334 |
4,034 |
$498K |
| D0120 |
Periodic oral evaluation - established patient |
21,136 |
20,090 |
$394K |
| D0330 |
Panoramic radiographic image |
8,118 |
7,664 |
$364K |
| D1110 |
Prophylaxis - adult |
9,934 |
9,436 |
$361K |
| D0274 |
Bitewings - four radiographic images |
17,730 |
16,722 |
$324K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,156 |
9,596 |
$279K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,566 |
13,897 |
$237K |
| D1120 |
Prophylaxis - child |
10,760 |
10,284 |
$229K |
| D2335 |
|
2,375 |
906 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,634 |
6,815 |
$105K |
| D2394 |
|
1,079 |
696 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,598 |
1,552 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,410 |
2,252 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
10,769 |
10,058 |
$57K |
| D1351 |
Sealant - per tooth |
2,626 |
661 |
$54K |
| D0272 |
Bitewings - two radiographic images |
5,004 |
4,776 |
$47K |
| D1320 |
|
1,569 |
1,474 |
$27K |
| D2160 |
|
386 |
186 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
30 |
14 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
376 |
177 |
$20K |
| D0240 |
|
2,057 |
798 |
$20K |
| D7240 |
Removal of impacted tooth - completely bony |
125 |
30 |
$13K |
| D2331 |
|
133 |
79 |
$8K |
| D9243 |
|
163 |
41 |
$7K |
| D2140 |
|
170 |
82 |
$7K |
| D2950 |
|
24 |
12 |
$3K |
| D9944 |
|
12 |
12 |
$3K |
| D9239 |
|
130 |
45 |
$3K |
| D2330 |
|
46 |
26 |
$2K |
| D2161 |
|
18 |
12 |
$1K |
| D9610 |
|
55 |
45 |
$1K |
| D0470 |
|
14 |
14 |
$308.28 |