| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,420 |
3,552 |
$452K |
| D4341 |
|
5,109 |
1,538 |
$335K |
| D1110 |
Prophylaxis - adult |
9,119 |
8,845 |
$321K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,297 |
1,630 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
11,615 |
11,222 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,454 |
2,293 |
$178K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,325 |
1,591 |
$174K |
| D0274 |
Bitewings - four radiographic images |
7,459 |
7,260 |
$158K |
| D1206 |
Topical application of fluoride varnish |
9,617 |
9,235 |
$145K |
| D1120 |
Prophylaxis - child |
4,839 |
4,604 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,735 |
4,559 |
$109K |
| D4910 |
|
1,777 |
1,758 |
$108K |
| D2740 |
Crown - porcelain/ceramic |
258 |
197 |
$90K |
| D2331 |
|
1,344 |
869 |
$85K |
| D0330 |
Panoramic radiographic image |
1,927 |
1,882 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,453 |
2,339 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,146 |
3,772 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
872 |
837 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
496 |
$20K |
| D2330 |
|
323 |
229 |
$16K |
| D2752 |
|
43 |
32 |
$15K |
| D1351 |
Sealant - per tooth |
721 |
164 |
$15K |
| D0601 |
|
2,943 |
2,906 |
$14K |
| D0603 |
|
2,732 |
2,679 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,874 |
1,193 |
$10K |
| D2335 |
|
122 |
88 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D2332 |
|
58 |
37 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
182 |
179 |
$4K |
| D0602 |
|
372 |
369 |
$2K |