| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,786 |
2,082 |
$643K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,017 |
1,811 |
$526K |
| D1110 |
Prophylaxis - adult |
6,132 |
6,090 |
$393K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,485 |
12,397 |
$291K |
| D1120 |
Prophylaxis - child |
6,433 |
6,382 |
$282K |
| D0120 |
Periodic oral evaluation - established patient |
8,899 |
8,837 |
$271K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,081 |
4,049 |
$229K |
| D2750 |
|
420 |
306 |
$199K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
962 |
600 |
$164K |
| D1351 |
Sealant - per tooth |
4,482 |
753 |
$154K |
| D0220 |
Intraoral - periapical first radiographic image |
12,513 |
12,354 |
$141K |
| D0274 |
Bitewings - four radiographic images |
5,343 |
5,306 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,039 |
532 |
$131K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
150 |
145 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,422 |
10,319 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,538 |
1,529 |
$72K |
| D0272 |
Bitewings - two radiographic images |
3,000 |
2,976 |
$52K |
| D2950 |
|
378 |
280 |
$31K |
| D0330 |
Panoramic radiographic image |
453 |
452 |
$22K |
| D4341 |
|
162 |
77 |
$14K |
| D2330 |
|
96 |
72 |
$9K |
| D3320 |
|
14 |
12 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
108 |
$6K |
| D1330 |
|
234 |
234 |
$1K |
| D0270 |
|
24 |
24 |
$228.00 |