| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,602 |
527 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,829 |
859 |
$141K |
| D0330 |
Panoramic radiographic image |
3,368 |
3,312 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,420 |
527 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,407 |
4,317 |
$114K |
| D1110 |
Prophylaxis - adult |
2,331 |
2,306 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
3,461 |
3,339 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,584 |
1,555 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
792 |
361 |
$51K |
| D0274 |
Bitewings - four radiographic images |
3,042 |
2,987 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
865 |
443 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
832 |
408 |
$44K |
| D1351 |
Sealant - per tooth |
1,323 |
230 |
$28K |
| D2140 |
|
652 |
293 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,663 |
1,648 |
$25K |
| D1120 |
Prophylaxis - child |
935 |
926 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,031 |
1,024 |
$17K |
| D2160 |
|
221 |
116 |
$14K |
| D2394 |
|
174 |
109 |
$13K |
| D2330 |
|
161 |
52 |
$8K |
| D7310 |
|
77 |
40 |
$7K |
| D2332 |
|
67 |
42 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,006 |
993 |
$5K |
| D7320 |
|
36 |
12 |
$4K |
| D4342 |
|
54 |
14 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
658 |
646 |
$3K |
| D0272 |
Bitewings - two radiographic images |
30 |
27 |
$300.00 |