| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,039 |
2,780 |
$672K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,946 |
1,637 |
$388K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,946 |
1,663 |
$308K |
| D1110 |
Prophylaxis - adult |
6,959 |
6,791 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
8,151 |
7,934 |
$189K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,143 |
799 |
$187K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,733 |
4,598 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
5,416 |
5,199 |
$180K |
| D0210 |
Intraoral - complete series of radiographic images |
2,321 |
2,202 |
$169K |
| D0274 |
Bitewings - four radiographic images |
4,828 |
4,715 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
8,052 |
7,667 |
$98K |
| D2740 |
Crown - porcelain/ceramic |
131 |
75 |
$78K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
339 |
210 |
$53K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
283 |
265 |
$50K |
| D9222 |
|
260 |
249 |
$27K |
| D7240 |
Removal of impacted tooth - completely bony |
93 |
38 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,315 |
1,255 |
$21K |
| D2331 |
|
113 |
69 |
$13K |
| D2750 |
|
15 |
13 |
$6K |
| D9219 |
|
151 |
146 |
$6K |
| D2950 |
|
52 |
28 |
$4K |
| D1120 |
Prophylaxis - child |
100 |
99 |
$3K |
| D2332 |
|
16 |
12 |
$2K |
| D0391 |
|
16 |
16 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$603.36 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$149.76 |