| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,953 |
1,872 |
$573K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,291 |
1,886 |
$527K |
| D0140 |
Limited oral evaluation - problem focused |
5,968 |
5,687 |
$238K |
| D1120 |
Prophylaxis - child |
3,178 |
3,127 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,523 |
2,488 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
4,117 |
4,044 |
$116K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,984 |
3,918 |
$91K |
| D1110 |
Prophylaxis - adult |
1,583 |
1,549 |
$86K |
| D0330 |
Panoramic radiographic image |
1,808 |
1,778 |
$78K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
663 |
238 |
$73K |
| D4341 |
|
806 |
342 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
668 |
272 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,485 |
1,458 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,003 |
1,968 |
$29K |
| D1330 |
|
2,954 |
2,906 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
52 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,613 |
1,547 |
$14K |
| D4355 |
|
134 |
134 |
$13K |
| D2332 |
|
76 |
37 |
$11K |
| D2950 |
|
33 |
27 |
$3K |
| D0460 |
|
86 |
85 |
$850.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
92 |
$511.04 |