| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,956 |
4,493 |
$1.13M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,046 |
3,400 |
$616K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,138 |
2,119 |
$553K |
| D2740 |
Crown - porcelain/ceramic |
800 |
557 |
$476K |
| D1110 |
Prophylaxis - adult |
6,560 |
6,557 |
$314K |
| D1351 |
Sealant - per tooth |
9,999 |
1,935 |
$306K |
| D1120 |
Prophylaxis - child |
7,312 |
7,312 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
10,219 |
10,217 |
$271K |
| D0210 |
Intraoral - complete series of radiographic images |
3,485 |
3,469 |
$245K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,525 |
8,525 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,208 |
1,282 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,609 |
3,609 |
$146K |
| D2394 |
|
738 |
495 |
$117K |
| D2950 |
|
735 |
530 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
6,087 |
5,999 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,549 |
2,549 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,539 |
4,455 |
$75K |
| D4341 |
|
507 |
144 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,663 |
1,649 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
293 |
110 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,433 |
1,433 |
$35K |
| D2332 |
|
267 |
166 |
$28K |
| D2335 |
|
155 |
99 |
$22K |
| D2330 |
|
250 |
162 |
$20K |
| D1206 |
Topical application of fluoride varnish |
440 |
440 |
$13K |
| D3320 |
|
17 |
15 |
$6K |
| D2331 |
|
25 |
16 |
$3K |
| D4910 |
|
40 |
40 |
$3K |