| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,866 |
2,399 |
$404K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,720 |
1,171 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,508 |
1,669 |
$197K |
| D1110 |
Prophylaxis - adult |
4,804 |
4,564 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,041 |
1,086 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,808 |
3,517 |
$157K |
| D0330 |
Panoramic radiographic image |
2,992 |
2,765 |
$154K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,619 |
5,766 |
$142K |
| D0274 |
Bitewings - four radiographic images |
4,022 |
3,742 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,801 |
4,542 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
7,767 |
6,981 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
3,102 |
2,638 |
$100K |
| D4355 |
|
1,356 |
1,263 |
$89K |
| D2335 |
|
740 |
430 |
$86K |
| D7311 |
|
888 |
520 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
727 |
431 |
$74K |
| D2332 |
|
698 |
421 |
$64K |
| D1120 |
Prophylaxis - child |
2,062 |
1,962 |
$56K |
| D2331 |
|
622 |
396 |
$48K |
| D1351 |
Sealant - per tooth |
1,834 |
361 |
$48K |
| D7250 |
|
471 |
143 |
$47K |
| D2394 |
|
287 |
207 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,378 |
2,215 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,218 |
2,117 |
$35K |
| D4341 |
|
343 |
133 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,143 |
1,065 |
$20K |
| D9110 |
|
324 |
277 |
$14K |
| D5212 |
|
26 |
24 |
$10K |
| D2330 |
|
112 |
67 |
$7K |
| D5422 |
|
79 |
51 |
$2K |
| D5421 |
|
47 |
37 |
$1K |
| D5411 |
|
20 |
13 |
$209.58 |