| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,664 |
2,048 |
$466K |
| D1351 |
Sealant - per tooth |
17,404 |
2,587 |
$462K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,825 |
1,923 |
$407K |
| D4341 |
|
3,116 |
1,256 |
$321K |
| D5211 |
|
550 |
548 |
$314K |
| D5212 |
|
502 |
500 |
$288K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,176 |
1,456 |
$273K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,599 |
638 |
$203K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,451 |
957 |
$195K |
| D7250 |
|
1,413 |
622 |
$192K |
| D0210 |
Intraoral - complete series of radiographic images |
2,828 |
2,804 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,338 |
4,306 |
$160K |
| D4355 |
|
1,365 |
1,360 |
$142K |
| D5110 |
|
179 |
179 |
$137K |
| D4342 |
|
1,973 |
827 |
$123K |
| D5214 |
|
143 |
142 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,745 |
2,129 |
$60K |
| D5120 |
|
65 |
65 |
$52K |
| D2950 |
|
406 |
243 |
$47K |
| D1110 |
Prophylaxis - adult |
786 |
781 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,018 |
981 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,406 |
2,332 |
$36K |
| D7310 |
|
319 |
146 |
$35K |
| D1120 |
Prophylaxis - child |
788 |
788 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,131 |
1,129 |
$30K |
| D0330 |
Panoramic radiographic image |
386 |
385 |
$24K |
| D4910 |
|
286 |
285 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
46 |
36 |
$21K |
| D0274 |
Bitewings - four radiographic images |
737 |
722 |
$20K |
| D7230 |
|
92 |
83 |
$19K |
| D2330 |
|
213 |
97 |
$15K |
| D2394 |
|
90 |
71 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
568 |
568 |
$14K |
| D2331 |
|
148 |
80 |
$14K |
| D2332 |
|
125 |
79 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
52 |
38 |
$9K |
| D4346 |
|
55 |
55 |
$3K |
| D7220 |
|
13 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
43 |
$893.84 |
| D0240 |
|
38 |
19 |
$844.56 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$589.93 |