| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,995 |
1,557 |
$150K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,604 |
661 |
$122K |
| D1110 |
Prophylaxis - adult |
4,357 |
4,035 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,482 |
1,207 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,517 |
937 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,187 |
3,820 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
2,211 |
2,003 |
$75K |
| D0330 |
Panoramic radiographic image |
1,808 |
1,671 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
3,063 |
2,770 |
$54K |
| D1351 |
Sealant - per tooth |
2,911 |
280 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
5,141 |
4,682 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,666 |
2,495 |
$41K |
| D2394 |
|
612 |
361 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,054 |
1,926 |
$36K |
| D1120 |
Prophylaxis - child |
1,616 |
1,527 |
$36K |
| D2332 |
|
371 |
192 |
$24K |
| D2335 |
|
301 |
156 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,786 |
2,295 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
396 |
135 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,104 |
1,046 |
$14K |
| D1206 |
Topical application of fluoride varnish |
848 |
783 |
$11K |
| D4341 |
|
153 |
70 |
$10K |
| D0272 |
Bitewings - two radiographic images |
316 |
282 |
$4K |
| D2330 |
|
68 |
37 |
$3K |
| D9910 |
|
79 |
40 |
$858.90 |
| D4355 |
|
29 |
27 |
$548.16 |
| D0270 |
|
30 |
28 |
$194.20 |
| D1330 |
|
113 |
100 |
$0.00 |
| D1310 |
|
110 |
97 |
$0.00 |
| D9215 |
|
40 |
20 |
$0.00 |