| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,541 |
8,518 |
$1.76M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,597 |
6,508 |
$982K |
| D1351 |
Sealant - per tooth |
28,293 |
4,975 |
$806K |
| D0120 |
Periodic oral evaluation - established patient |
20,796 |
20,773 |
$555K |
| D1120 |
Prophylaxis - child |
13,655 |
13,643 |
$543K |
| D1110 |
Prophylaxis - adult |
9,425 |
9,419 |
$476K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,042 |
2,406 |
$436K |
| D0274 |
Bitewings - four radiographic images |
15,923 |
15,862 |
$402K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,143 |
14,128 |
$338K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,818 |
2,651 |
$328K |
| D2740 |
Crown - porcelain/ceramic |
579 |
486 |
$310K |
| D0330 |
Panoramic radiographic image |
3,601 |
3,593 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,001 |
3,998 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
3,679 |
3,606 |
$151K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
943 |
634 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
7,728 |
7,430 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
2,688 |
2,554 |
$115K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
180 |
173 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,829 |
3,828 |
$103K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
800 |
633 |
$92K |
| D2950 |
|
565 |
523 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,517 |
2,499 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,138 |
4,427 |
$48K |
| D4341 |
|
323 |
146 |
$33K |
| D2710 |
|
43 |
41 |
$28K |
| D1510 |
|
87 |
75 |
$17K |
| D2332 |
|
122 |
80 |
$13K |
| D3320 |
|
24 |
24 |
$13K |
| D9310 |
|
136 |
135 |
$4K |
| D2330 |
|
33 |
26 |
$3K |
| D4910 |
|
40 |
40 |
$3K |
| D3110 |
|
43 |
32 |
$2K |
| D2331 |
|
14 |
13 |
$1K |
| D0270 |
|
123 |
121 |
$438.41 |
| D0350 |
|
23 |
23 |
$0.00 |