| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,021 |
2,854 |
$857K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,546 |
3,534 |
$824K |
| D2740 |
Crown - porcelain/ceramic |
852 |
722 |
$497K |
| D1110 |
Prophylaxis - adult |
6,538 |
6,158 |
$311K |
| D5226 |
|
441 |
361 |
$253K |
| D2394 |
|
1,342 |
885 |
$250K |
| D1320 |
|
7,075 |
6,611 |
$244K |
| D0274 |
Bitewings - four radiographic images |
6,449 |
6,066 |
$205K |
| D1206 |
Topical application of fluoride varnish |
9,666 |
9,024 |
$190K |
| D0330 |
Panoramic radiographic image |
3,778 |
3,527 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
7,928 |
7,470 |
$184K |
| D5225 |
|
323 |
258 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,734 |
1,618 |
$170K |
| D3120 |
|
5,400 |
2,962 |
$163K |
| D4341 |
|
885 |
394 |
$146K |
| D0367 |
|
480 |
466 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,489 |
3,268 |
$113K |
| D1354 |
|
5,232 |
1,217 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
3,080 |
2,845 |
$99K |
| D2950 |
|
802 |
680 |
$95K |
| D2335 |
|
653 |
371 |
$81K |
| D4910 |
|
1,249 |
1,203 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,690 |
3,993 |
$75K |
| D2331 |
|
706 |
464 |
$67K |
| D2332 |
|
606 |
369 |
$63K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
451 |
242 |
$55K |
| D4342 |
|
589 |
289 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
775 |
257 |
$52K |
| D1120 |
Prophylaxis - child |
1,281 |
1,199 |
$43K |
| D1351 |
Sealant - per tooth |
1,644 |
440 |
$42K |
| D2330 |
|
647 |
426 |
$40K |
| D9110 |
|
484 |
433 |
$30K |
| D9920 |
|
155 |
140 |
$16K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
30 |
$15K |
| D9940 |
|
33 |
32 |
$10K |
| D0272 |
Bitewings - two radiographic images |
347 |
323 |
$7K |
| D9944 |
|
27 |
25 |
$6K |
| D0603 |
|
587 |
537 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
692 |
427 |
$6K |
| D1310 |
|
217 |
213 |
$5K |
| D1330 |
|
343 |
328 |
$5K |
| D9630 |
|
311 |
282 |
$5K |
| D0270 |
|
151 |
146 |
$2K |
| D3110 |
|
62 |
46 |
$2K |
| D0602 |
|
125 |
112 |
$1K |
| D4355 |
|
16 |
12 |
$913.55 |
| D9987 |
|
93 |
90 |
$0.00 |