| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,718 |
4,318 |
$562K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,221 |
4,645 |
$506K |
| D1110 |
Prophylaxis - adult |
11,577 |
11,502 |
$410K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,405 |
13,333 |
$360K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,125 |
3,309 |
$307K |
| D0330 |
Panoramic radiographic image |
10,516 |
10,443 |
$294K |
| D0140 |
Limited oral evaluation - problem focused |
9,399 |
9,218 |
$224K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,582 |
1,798 |
$224K |
| D5110 |
|
462 |
459 |
$210K |
| D0274 |
Bitewings - four radiographic images |
11,857 |
11,784 |
$208K |
| D0120 |
Periodic oral evaluation - established patient |
8,492 |
8,452 |
$186K |
| D1120 |
Prophylaxis - child |
4,765 |
4,762 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,418 |
2,237 |
$176K |
| D0220 |
Intraoral - periapical first radiographic image |
19,868 |
19,261 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
3,953 |
3,028 |
$121K |
| D1206 |
Topical application of fluoride varnish |
4,759 |
4,756 |
$112K |
| D5120 |
|
240 |
239 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,197 |
14,203 |
$89K |
| D1351 |
Sealant - per tooth |
2,397 |
624 |
$68K |
| D4341 |
|
568 |
205 |
$64K |
| D2331 |
|
886 |
644 |
$56K |
| D2332 |
|
667 |
450 |
$52K |
| D2950 |
|
311 |
229 |
$51K |
| D2330 |
|
1,009 |
579 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
70 |
40 |
$43K |
| D7310 |
|
447 |
237 |
$43K |
| D5214 |
|
88 |
87 |
$41K |
| D2335 |
|
316 |
218 |
$31K |
| D5213 |
|
46 |
46 |
$25K |
| D2394 |
|
136 |
97 |
$13K |
| D4910 |
|
165 |
165 |
$12K |
| D7230 |
|
106 |
95 |
$11K |
| D7250 |
|
171 |
92 |
$10K |
| D3320 |
|
20 |
17 |
$10K |
| D0272 |
Bitewings - two radiographic images |
473 |
471 |
$9K |
| D4342 |
|
76 |
27 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
160 |
160 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
137 |
$3K |
| D1999 |
|
18 |
18 |
$0.00 |